损伤严重评分与修正创伤评分对创伤病人自发性低体温的预测价值比较

Comparison of the predictive value of Injury Severity Scale and Revised Trauma Score on hypothermia in trauma patients

目的:比较损伤严重评分(Injury Severity Scale,ISS)与修正创伤评分(Revised Trauma Score,RTS)对创伤病人自发性低体温的预测价值。方法:采用便利抽样法选择南通大学附属医院急诊创伤中心急诊创伤病人218例为研究对象,收集其临床资料,根据体温值将创伤病人分为低体温组(<36℃)和非低体温组(≥36℃),使用ISS与RTS进行创伤评分,使用二元Logistic回归分析和受试者工作特征曲线(ROC)曲线评价ISS与RTS对急诊创伤病人低体温的预测价值。结果:218例创伤病人中低体温发生率为36.24%;二元Logistic回归分析显示创伤病人自发性低体温的影响因素有ISS评分、RTS评分、Glasgow评分、是否有衣物潮湿;ISS和RTS预测创伤病人自发性低体温的ROC曲线下面积(AUC)分别为0.885,0.813,,两者AUC比较差异有统计学意义(P<0.05)。特异度分别为0.827,0.813,敏感度分别为0.797,0.759,预测界值分别是17分、6分。结论:ISS对创伤病人自发性低体温的预测价值高于RTS,RTS适用于院前以及急诊创伤病人的低体温预测,ISS则适用于住院或重症监护室创伤病人自发性低体温的预测。

Objective:To compare the predictive value of RTS and ISS on hypothermia in trauma patients.Methods:Totally 218 emergency trauma patients were chosen by convenient sampling cross-sectional method form emergency trauma center in Affiliated Hospital of Nantong University,clinical information were collected,and trauma patients were divided into hypothermia group(<36 ℃)and non-hypothermia group(≥36 ℃)according to body temperature. Trauma severity was scored by RTS and ISS. The predictive value of RTS and ISS scores on hypothermia in emergency trauma patients were evaluated using binary Logistic regression and ROC curve.Results:The incidence of hypothermia in 218 trauma patients was 36. 24%. Binary Logistic regression analysis showed that the influencing factors of hypothermia in trauma patients were ISS,RTS,GCS and whether there was damp clothing. The ROC curve showed that the AUC predicted by ISS and RTS for traumatic hypothermia were 0. 885,0. 813,the differences were all statistically significant(P<0. 05). While the cut-off were 17 and 6,the sensitivity were 0. 797,0. 759,the specificity were 0. 827,0. 813.Conclusion:The prediction value of ISS on hypothermia in trauma patients was higher than that of RTS. RTS was applicable for the prediction of hypothermia in pre-hospital and emergency trauma patients,while ISS was suitable for the prediction of hypothermia in hospitalized or ICU trauma patients.