Gröbli Lea, Kalbas Yannik, Kessler Franziska, Hax Jakob, Michel Teuben, Sprengel Kai, Pfeifer Roman, Mächler Martin, Pape Hans-Christoph, Halvachizadeh Sascha, Klingebiel Felix Karl-Ludwig
Department of Trauma Surgery, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
Harald-Tscherne Laboratory for Orthopaedic and Trauma Research, University Hospital Zurich, University of Zurich, Raemistr. 100, 8091, Zurich, Switzerland.
Eur J Med Res. 2025 Apr 2;30(1):228. doi: 10.1186/s40001-025-02477-8.
Numerous studies have investigated variables that predict mortality and complications following severe trauma. These studies, however, mainly focus on admission values or a single variable. The aim of this study was to investigate the predictive quality of multiple routine clinical measurements (at admission and in the ICU).
Retrospective cohort study of severely injured patients treated at one Level 1 academic trauma centre.
severe injury (ISS ≥ 16 points), primary admission and complete data set. Exclusion criteria end-of-life treatment based on advanced directive, secondary transferred patients.
mortality, pneumonia, sepsis. Routine clinical parameters were stratified based on measurement timepoint into Group TB (Trauma Bay, admission) and into Group intensive care unit (ICU, 72 h after admission). Prediction of complications and mortality were calculated using two prediction methods: adaptive boosting (AdaBoost, artificial intelligence, AI) and LASSO regression analysis.
Inclusion of 3668 cases. Overall mean age 45.5 ± 20 years, mean ISS 28.2 ± 15.1 points, incidence pneumonia 19.0%, sepsis 14.9%, death from haemorrhagic shock 4.1%, death from multiple organ failure 1.9%, overall mortality rate 26.8%. Highest predictive value for complications for Group TB include abbreviated injury scale (AIS), new injury severity score (NISS) and systemic Inflammatory Response Syndrome (SIRS) score. Highest predictive quality for complications for Group ICU include late lactate values, haematocrit, leukocytes, and CRP. Sensitivity and specificity of late prediction models using a 25% cutoff were 73.61% and 76.24%, respectively.
The predictive quality of routine clinical measurements strongly depends on the timepoint of the measurement. Upon admission, the injury severity and affected anatomical regions are more predictive, while during the ICU stay, laboratory parameters are better predictor of adverse outcomes. Therefore, the dynamics of pathophysiologic responses should be taken into consideration, especially during decision making of secondary definitive surgical interventions.
III (retrospective cohort study).
众多研究探讨了预测严重创伤后死亡率和并发症的变量。然而，这些研究主要关注入院时的值或单一变量。本研究的目的是调查多项常规临床测量指标（入院时和在重症监护病房[ICU]）的预测质量。
对在一家一级学术创伤中心接受治疗的重伤患者进行回顾性队列研究。
重伤（损伤严重度评分[ISS]≥16分）、初次入院且数据集完整。排除标准：基于预先指示的临终治疗、二次转诊患者。
死亡率、肺炎、脓毒症。常规临床参数根据测量时间点分为TB组（创伤室，入院时）和ICU组（入院72小时后）。使用两种预测方法计算并发症和死亡率的预测值：自适应增强算法（AdaBoost，人工智能，AI）和套索回归分析。
纳入3668例病例。总体平均年龄45.5±20岁，平均ISS为28.2±15.1分，肺炎发生率19.0%，脓毒症发生率14.9%，失血性休克死亡率4.1%，多器官功能衰竭死亡率1.9%，总死亡率26.8%。TB组对并发症预测价值最高的指标包括简明损伤定级标准（AIS）、新损伤严重度评分（NISS）和全身炎症反应综合征（SIRS）评分。ICU组对并发症预测质量最高的指标包括晚期乳酸值、血细胞比容、白细胞和C反应蛋白（CRP）。使用25%临界值的晚期预测模型的敏感度和特异度分别为73.61%和76.24%。
常规临床测量的预测质量很大程度上取决于测量时间点。入院时，损伤严重程度和受影响的解剖区域预测性更强，而在ICU住院期间，实验室参数是不良结局的更好预测指标。因此，应考虑病理生理反应的动态变化，尤其是在二次确定性手术干预的决策过程中。
III级（回顾性队列研究）
