改良修正创伤评分预测急诊躯干伤28天内生存预后的效能分析

Analysis on Effect of Using Hemoglobin-revised Trauma Score on Predicting the Prognosis of Emergency Trunk Injury within 28 Days

目的探讨改良修正创伤评分(HB-RTS)系统对躯干伤伤员死亡风险的预测效能。方法按照1︰1配对的病例对照研究的原则,收集2011年7月-2013年10月收治的躯干伤伤员的临床资料,依据伤员受伤28 d内的生存预后进行分组。分别计算两组伤员的HB-RTS、修正创伤评分(RTS)、创伤严重度评分(ISS)。并进一步绘制受试者工作特征(ROC)曲线,计算出曲线下面积(AUC)和约登指数。然后,依此筛选出HB-RTS评分和RTS评分预测躯干伤伤员死亡的最佳截断值,计算二者的灵敏度、特异度和准确率等指标。最终采用线性相关分析探究HB-RTS评分和RTS评分与ISS评分的相关性。结果除RTS评分之外,死亡组伤员的HB-RTS评分与ISS评分均高于存活组,差异有统计学意义(P<0.05);两组的HB-RTS和RTS的AUC分别为0.922和0.888,灵敏度分别为91.5%和83.0%,特异度分别为95.7%和76.6%。同时,RTS和HB-RTS评分分别与ISS评分的相关系数为-0.592和0.585。结论 HB-RTS评分较RTS评分的ROC曲线AUC大、特异度升高、灵敏度下降;HB-RTS评分与ISS评分的相关性较RTS评分强。HB-RTS评分系统对躯干伤伤员对死亡预测效能较RTS评分更高。

Objective To investigate the effect of using hemoglobin-revised trauma score （HB-RTS） on predicting mortality risk in trunk injury patients. Methods According to ease control study rules, medical records of patients with trunk injury who were treated between July 2011 and October 2013, were collected. Patients were divided into two groups according to their survival prognosis within 28 days. The HB-RTS, revised trauma score （RTS）, and injury severity score （ISS） of the two groups were calculated. The receiver operating characteristic （ROC） curve was drawn, and the area under the curve （AUC） and Youden＇s index were calculated. And then, we selected the optimal cutoff value using HB-RTS and RTS to predict the trunk injury patients＇ mortality and calculated their sensitivity, specificity, and accuracy. In the end, the correlation of ISS with HB-RTS and RTS using linear correlation analysis method was analyzed. Results Besides RTS, HB-RTS and ISS in the death group were statistically significant higher than that in the survival group. The AUC of HB- RTS and RTS of the two groups were 0.922 and 0.888, respectively. The sensitivity of HB-RTS and RTS were 91.5% and 83%; and the specificity of HB-RTS and RTS were 95.7% and 76.6%, respectively. The correlation of HB-RTS and ISS was -0.592, while the correlation of RTS and ISS was 0.585. Conclusions Compared to RTS, ROC of HB-RTS is enlarged, the specificity is increased, and the sensitivity is decreased. HB-RTS has stronger correlation with ISS than with RTS. The predictive effect of HB-RTS is higher than RTS in predicting mortality of trunk injury patients.