Laajimi Sondes, Bhiri Sana, Chebbi Nabil, Bradai Haifa, Belkhiria Amal, Loghmari Dorra, Chebili Naoufel, Mbarek Rabeb, Kahloul Mohamed
Emergency medical service (EMS/SAMU03) Sahloul University Hospital, Sousse,Tunisia.
Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia.
Tunis Med. 2024 Dec 5;102(12):1055-1061. doi: 10.62438/tunismed.v102i12.5198.
Introduction-Aim: Validated triage tools such as the Vittel criteria are essential to improve the care of trauma patients. The aim of this study was to evaluate the correlation between the Vittel triage criteria and the Injury Severity Score (ISS) to improve the accuracy of pre-hospital triage.
We conducted a longitudinal study of all trauma patients transported by EMS over a two-year period (November 2021- November 2023). Vittel and (ISS) scores were calculated on admission. Predictive Vittel criteria were defined by independent risk factors for ISS>15 using a multiple logistic regression model with p-value < 0.05 and/or sensitivity (se)>50%, with positive Youden index (Yi).
A total of 461 trauma patients were transported by EMS during the study period were included. The sex ratio was 5.3 and road traffic accidents accounted for 77.2%. An ISS>15 was found in 41% of participants, 25% required ICU admission and 23.9% died within 30 days. Using the above selection criteria, we identified seven key predictive criteria (OR CI 95%, se%, Yi) Glasgow coma scale<13(3.16 [1.91 5.24],44,0.25); fall>6 m(4.031[1.61-10.08],10,0.07); severe burn(23.89[10.21-55.93],6,0.02); Pelvic fracture (4.93 [1.19-20.32], 28, 0.25),suspected spinal cord injury(6.89 [2.79-16.96], 6, 0.05); Fluid resuscitation>1000 ml(-, 60.0. 11); Catecholamine (2.02 [1.09-3.75],51.0.27). Physiological variables (se 30%, Yi 0.16) and pre-hospital resuscitation(se 46%, Yi 0.18) were among the most relevant categories for predicting severity, similar to the full Vittel score.
Seven criteria were associated with severe trauma (ISS score >15). Physiological variables and pre-hospital resuscitation were significant categories that may help to predict the severity of trauma and its impact on patients.
引言-目的：经过验证的分诊工具，如维特尔标准，对于改善创伤患者的护理至关重要。本研究的目的是评估维特尔分诊标准与损伤严重程度评分（ISS）之间的相关性，以提高院前分诊的准确性。
我们对在两年期间（2021年11月至2023年11月）由紧急医疗服务（EMS）转运的所有创伤患者进行了一项纵向研究。入院时计算维特尔评分和（ISS）评分。使用p值<0.05和/或敏感度（se）>50%且约登指数（Yi）为正的多元逻辑回归模型，通过ISS>15的独立危险因素定义预测性维特尔标准。
在研究期间，共有461例由EMS转运的创伤患者被纳入。男女比例为5.3，道路交通事故占77.2%。41%的参与者ISS>15，25%需要入住重症监护病房，23.9%在30天内死亡。使用上述选择标准，我们确定了七个关键预测标准（OR CI 95%，se%，Yi）：格拉斯哥昏迷量表<13（3.16 [1.91 5.24]，44，0.25）；坠落>6米（4.031[1.61 - 10.08]，10，0.07）；严重烧伤（23.89[10.21 - 55.93]，6，0.02）；骨盆骨折（4.93 [1.19 - 20.32]，28，0.25），疑似脊髓损伤（6.89 [2.79 - 16.96]，6，0.05）；液体复苏>1000毫升（-，60.0. 11）；儿茶酚胺（2.02 [1.09 - 3.75]，51.0.27）。生理变量（se 30%，Yi 0.16）和院前复苏（se 46%，Yi 0.18）是预测严重程度最相关的类别，与完整的维特尔评分相似。
七个标准与严重创伤（ISS评分>15）相关。生理变量和院前复苏是重要类别，可能有助于预测创伤的严重程度及其对患者的影响。
