老年创伤患者院内死亡的影响因素分析

目的分析老年创伤患者院内死亡的影响因素。方法收集2019年7月至2023年6月312例老年创伤患者的临床资料,按照住院期间是否死亡分为死亡组54例与存活组258例,比较两组性别、年龄、体质量指数、创伤机制及部位、实验室指标、格拉斯哥昏迷评分(GCS)与老年创伤结局评分(GTOS)等指标,采用多因素Logistic回归模型分析老年创伤患者院内死亡的独立影响因素。结果死亡组患者在年龄、入院时体温、血清肌酐、氧合指数、GTOS得分和GCS得分方面与存活组比较,差异有统计学意义(P<0.05)。Logistic回归模型分析显示,年龄≥75岁、血清肌酐≥109μmol/L、GTOS≥130分为老年创伤患者院内死亡的独立危险因素(P<0.05),GCS≥12分是保护性因素(P<0.05)。老年创伤患者院内死亡列线图预测模型的ROC曲线下面积为0.976,校准曲线分析发现模型具有良好的校准度。结论年龄、血清肌酐、GTOS及GCS均可作为老年创伤患者院内死亡的影响因素,基于上述指标绘制的列线图能够帮助医师早期甄别患者病情及死亡风险。

Objective To study the influencing factors of hospital death in elderly trauma patients.Methods A retrospective study was conducted on 312 elderly trauma patients treated at Jinhua Traditional Chinese Medicine Hospital from July 2019 to June 2023.They were divided into a death group of 54 cases and a survival group of 258 cases based on whether they died during hospitalization.The indicators for comparison,including gender,age,body mass index,trauma mechanism,trauma site,laboratory indicators,Glasgow Coma Scale(GCS),and GTOS were collected and analyzed.A multivariate Logistic regression model was used to screen for independent influencing factors of hospital death in elderly trauma patients and draw a column chart.Results The death group patients were compared with the survival group in terms of age,admission temperature,serum creatinine,oxygenation index,GTOS score,and GCS score,the difference was statistically significant(P<0.05).Logistic regression model analysis found that,age≥75 years old,serum creatinine≥109μmol and GTOS scores≥130 were independent risk factors for hospital death in elderly trauma patients(P<0.05),while GCS scores≥12 were protective factors(P<0.05).The area under the ROC curve of the column chart prediction model for hospital mortality in elderly trauma patients was 0.976,and calibration curve analysis showed that the model had good calibration.Conclusion Age,serum creatinine,GTOS score,and GCS score can be used as influencing factors for in-hospital mortality in elderly trauma patients,and a column chart based on these indicators can help physicians to screen patients'conditions and risk of death at an early stage.