Hagebusch Paul, Scheidt Nils, Koch Daniel, Klug Alexander, Schweigkofler Uwe, Faul Philipp
Department of Traumasurgery and Orthopedics, BG Unfallklinik Frankfurt am Main gGmbH, Friedberger Landstr. 430, 60389, Frankfurt Am Main, Germany.
Eur J Trauma Emerg Surg. 2025 Jun 11;51(1):226. doi: 10.1007/s00068-025-02896-6.
Accurate trauma triage ensures timely and specialized care for potentially critically injured patients. Undertriage remains a concern, particularly for patients without obvious vital sign derangements. This study evaluates the potential of biomarkers such as lactate, base deficit (BD), and blood glucose to improve triage score accuracy in identifying patients with severe injuries (Injury Severity Score [ISS] > 15) and predicting intensive care unit (ICU) admission without a high risk of severe injury (HRSI).
This retrospective, single-center cohort study (2017-2021) included trauma patients with trauma team activation (TTA) due to mechanism of injury(MOI) and therefore only patients with moderate risk of severe injury criteria(MRSI). Exclusion criteria were any HRSI-criterion such as advanced airway management, Glasgow Coma Scale < 12, systolic blood pressure < 90 mmHg, and specific injury patterns. Biomarkers were collected upon emergency department (ED) admission. Logistic regression and receiver operating characteristic (ROC) curve analyses evaluated biomarker predictive value alone and in combination with existing triage scores.
The study population included 3371 TTAs of which we were able to include 302 in our study-group. 15% had ISS > 15. These patients had significantly higher lactate (2.38 ± 1.2 vs. 1.57 ± 0.75 mmol/L, p < 0.05), BD (-0.2 ± 5.0 vs. 1.7 ± 2.7 mmol/L, p < 0.05), and blood glucose (144.8 ± 46.0 vs. 118 ± 37.9 mg/dL, p < 0.05). Augmenting triage scores with lactate improved predictive accuracy, with the highest AUC (0.774) observed for the age-lactate model. ICU admission prediction was less robust (AUC = 0.674).
Our findings suggest that biomarkers such as lactate could strengthen trauma triage scores, but prospective, multicenter validation is essential to confirm these preliminary results.
准确的创伤分诊可确保为潜在的重伤患者提供及时且专业的治疗。分诊不足仍是一个问题，尤其是对于生命体征无明显紊乱的患者。本研究评估了乳酸、碱缺失（BD）和血糖等生物标志物在提高分诊评分准确性方面的潜力，以识别重伤患者（损伤严重程度评分[ISS]＞15）并预测无需高重伤风险（HRSI）的重症监护病房（ICU）入院情况。
这项回顾性单中心队列研究（2017 - 2021年）纳入了因损伤机制（MOI）而启动创伤团队（TTA）的创伤患者，因此仅纳入中度重伤风险标准（MRSI）的患者。排除标准为任何HRSI标准，如高级气道管理、格拉斯哥昏迷量表＜12、收缩压＜90 mmHg以及特定损伤模式。在急诊科（ED）入院时收集生物标志物。逻辑回归和受试者工作特征（ROC）曲线分析评估了生物标志物单独以及与现有分诊评分联合使用时的预测价值。
研究人群包括3371次TTA，其中我们能够将302例纳入研究组。15%的患者ISS＞15。这些患者的乳酸水平显著更高（2.38±1.2 vs. 1.57±0.75 mmol/L，p＜0.05）、BD（-0.2±5.0 vs. 1.7±2.7 mmol/L，p＜0.05）和血糖（144.8±46.0 vs. 118±37.9 mg/dL，p＜0.05）。用乳酸增强分诊评分可提高预测准确性，年龄 - 乳酸模型的AUC最高（0.774）。ICU入院预测的稳健性较差（AUC = 0.674）。
我们的研究结果表明，乳酸等生物标志物可加强创伤分诊评分，但前瞻性多中心验证对于证实这些初步结果至关重要。
