Zhang Cong, Zhang Peidong, Chen Deng, Wan Qian, Yin Gang, Liu Yang, Luo Jialiu, Chen Shunyao, Lin Zhiqiang, Gu Shuaipeng, Li Hui, Dong Liming, Chang Teding, Tang Zhaohui
Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
Department of Trauma Surgery, Trauma Center, Xiantao First People's Hospital Affiliated to Yangtze University, Xiantao, 433000, China.
Arch Public Health. 2024 Nov 27;82(1):226. doi: 10.1186/s13690-024-01460-9.
Polytrauma was defined as a severe traumatic injury and believed that it was a sudden and unpredictable incident. Is polytrauma really just a simple accident? In order to comprehensively answer this question, the study sought to determine the frequency and specific risk factors associated with polytrauma recidivism, while also comparing the initial and subsequent injury events among recidivists.
A multicenter, retrospective cohort study was conducted at four Advanced Trauma Centers' emergency surgery or traumatic intensive care units (TICUs) between August 2020 and July 2023. A total of 2490 consecutive trauma patients who met the criteria consecutively were recruited and analyzed in the study. Risk factors for recurrent polytrauma were identified through the use of logistic regression analysis. A nomogram was created using the results from a multivariate logistic regression analysis and the rms package in R.
In polytrauma, the rate of recidivism was 44.6% (672/1507), then recidivists were predominantly male (80.4%) and frequently within the 45 to 54 year-old age range (51.3%). Recidivists in polytrauma patients overall had a median time to reinjury of 27 months, as measured by the interquartile range (IQR). The polytrauma patients in the recent traumatic event were often more severe than that in the initial event, as patients had higher ISS scores and lower GCS scores (P < 0.01). Moreover, polytrauma recidivism were associated with poorer prognosis and increased healthcare costs. Polytrauma patients with the specific characteristics were found to have a higher likelihood of experiencing a subsequent recurrence, including being male (OR = 3.82,95% CI: 2.21-6.83), aged 45-54 years old (OR = 2.62,95% CI: 2.13-6.32),experiencing sleep deprivation (OR = 2.38,95% CI: 1.32-4.25), working in construction (OR = 2.72,95% CI: 1.44-5.42), working as delivery staff (OR = 3.65,95% CI: 1.51-7.96) and being involved in an electric bicycle collision (OR = 2.85,95% CI: 1.31-5.64).
Polytrauma recidivism is associated with a high recurrence rate, poorer clinical outcomes, and elevated healthcare costs. Key predictive markers for recidivism include being male, aged 45-54 years, experiencing sleep deprivation, employment in construction or delivery roles, and involvement in electric bicycle collisions. These findings highlight polytrauma recidivists as a critical target for primary prevention efforts. Public health strategies should prioritize tailored interventions to reduce recidivism, aiming to mitigate morbidity, mortality, and associated healthcare burdens in this high-risk population.
多发伤被定义为严重创伤性损伤，人们认为这是一种突发且不可预测的事件。多发伤真的只是一场简单的意外吗？为了全面回答这个问题，该研究试图确定与多发伤复发相关的频率和具体风险因素，同时比较复发者最初和随后的损伤事件。
2020年8月至2023年7月期间，在四个高级创伤中心的急诊外科或创伤重症监护病房（TICU）进行了一项多中心回顾性队列研究。该研究共招募并分析了2490例连续符合标准的创伤患者。通过逻辑回归分析确定复发性多发伤的风险因素。使用多元逻辑回归分析结果和R语言中的rms包创建了一个列线图。
在多发伤中，复发率为44.6%（672/1507），复发者以男性为主（80.4%），且经常处于45至54岁年龄范围（51.3%）。多发伤患者复发者再次受伤的中位时间为27个月，通过四分位间距（IQR）测量。近期创伤事件中的多发伤患者往往比初次事件中的更严重，因为患者的损伤严重度评分（ISS）更高，格拉斯哥昏迷评分（GCS）更低（P<0.01）。此外，多发伤复发与较差的预后和医疗费用增加有关。发现具有特定特征的多发伤患者更有可能经历后续复发，包括男性（比值比[OR]=3.82，95%置信区间[CI]：2.21-6.83）、年龄在45-54岁（OR=2.62，95%CI：2.13-6.32）、经历睡眠剥夺（OR=2.38，95%CI：1.32-4.25）、从事建筑工作（OR=2.72，95%CI：1.44-5.42）、从事快递员工作（OR=3.65，95%CI：1.51-7.96）以及卷入电动自行车碰撞事故（OR=2.85，95%CI：1.31-5.64）。
多发伤复发与高复发率、较差的临床结局和医疗费用升高有关。复发的关键预测指标包括男性、年龄在45-54岁、经历睡眠剥夺、从事建筑或快递工作以及卷入电动自行车碰撞事故。这些发现凸显多发伤复发者是一级预防工作的关键目标。公共卫生策略应优先采取针对性干预措施以降低复发率，旨在减轻这一高危人群的发病率、死亡率和相关医疗负担。
