严重创伤患者中致死三联征与致死四角的比较：一项多中心队列研究

Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort.

作者信息

Dupuy Charles, Martinez Thibault, Duranteau Olivier, Gauss Tobias, Kapandji Natacha, Pasqueron Jean, Holleville Mathilde, Abi Abdallah Georges, Harrois Anatole, Ramonda Véronique, Huet-Garrigue Delphine, Doublet Théophane, Leone Marc, Legros Vincent, Pottecher Julien, Audibert Gérard, Millot Ingrid, Popoff Benjamin, Cohen Benjamin, Vardon-Bounes Fanny, Willig Mathieu, Gosset Pierre, Angles Emilie, Mellati Nouchan, Higel Nicolas, Boutonnet Mathieu, Pasquier Pierre

机构信息

Faculty of Medicine, Université Paris Cité, Paris, France.

Federation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training Hospital, 2 Rue Lieutenant Raoul Batany, 92140, Clamart, France.

出版信息

World J Emerg Surg. 2025 Jan 7;20(1):2. doi: 10.1186/s13017-024-00572-5.

DOI:10.1186/s13017-024-00572-5

PMID:39773274

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11705660/

Abstract

BACKGROUND

To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-h mortality in severe trauma patients receiving transfusion.

METHODS

We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011-2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of red blood cells (RBCs) within the first 6 h of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L.

RESULTS

A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26-57; median injury severity score: 27, IQR: 17-41). Patients primarily presented with blunt trauma (81.7%), and a 24-h mortality rate of 16.1% was observed. Receiver operating characteristic curve analysis revealed no significant difference in the association with 24-h mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-h mortality was similar between the lethal triad and the lethal diamond, with Cramer's V values of 0.29 and 0.28, respectively.

CONCLUSIONS

This study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-h mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality.

摘要

背景

为减少失血导致的死亡人数，严重创伤的初始处理旨在预防（若无法限制）由酸中毒、凝血功能障碍和低体温组成的致死三联征。最近，多项研究建议将低钙血症加入致死三联征以形成致死四联征，但支持这一改变的证据有限。因此，本研究的目的是比较致死三联征和致死四联征与接受输血的严重创伤患者24小时死亡率的各自关联。

方法

我们对法国数据库TraumaBase®（2011 - 2023年）中的患者进行了多中心回顾性分析。本研究纳入的患者为所有在入院后6小时内接受了至少1单位红细胞（RBC）输血且有离子钙测量值的创伤患者。低钙血症定义为离子钙水平<1.1 mmol/L。

结果

共纳入2141例严重创伤患者（中位年龄：39岁，四分位间距[IQR]：26 - 57岁；中位损伤严重程度评分：27分，IQR：17 - 41分）。患者主要为钝性创伤（81.7%），观察到24小时死亡率为16.1%。受试者工作特征曲线分析显示，致死四联征（曲线下面积[AUC]：0.71）和致死三联征（AUC：0.72）与24小时死亡率的关联无显著差异（p = 0.26）。致死三联征和致死四联征与24小时死亡率的关联强度相似，Cramer's V值分别为0.29和0.28。