Application value of machine learning models in predicting intraoperative hypothermia in laparoscopic surgery for polytrauma patients

BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications.Machine learning models offer a promising approach to predict the occurrence of intraoperative hypothermia.AIM To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple trauma.METHODS This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December 2023.Of these,154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 ratio.In the training set,53 cases experienced intraoperative hypothermia and 101 did not.Logistic regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic surgery.The area under the curve(AUC),sensitivity,and specificity were calculated.RESULTS Comparison of the hypothermia and non-hypothermia groups found significant differences in sex,age,baseline temperature,intraoperative temperature,duration of anesthesia,duration of surgery,intraoperative fluid infusion,crystalloid infusion,colloid infusion,and pneumoperitoneum volume(P<0.05).Differences between other characteristics were not significant(P>0.05).The results of the logistic regression analysis showed that age,baseline temperature,intraoperative temperature,duration of anesthesia,and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery(P<0.05).Calibration curve analysis showed good consistency between the predicted occurrence of intraoperative hypothermia and the actual occurrence(P>0.05).The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets,respectively.CONCLUSION Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery,which improved surgical safety and patient recovery.

What are the ten new commandments in severe polytrauma management？

This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.

Management of polytrauma patients in emergency department:An experience of a tertiary care health institution of northern India

BACKGROUND:In a tertiary care institute of northern India,the emergency department receives an average of 6-7 patients with poly trauma every day.Of these patients,some come directly and many are referred from other hospitals from the region.Various problems are faced in the management of patients with poly trauma.This study aimed to elicit various complaints,suggestions and possible solutions in the management of patients with poly trauma.METHODS:A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 months.All the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps(step Ⅰ to step Ⅵ).RESULTS:In the younger generation,males were predominantly the primary victims of poly trauma injury,and road traffic accident was the major etiological factor.Injuries involving more than2 specialties induced many problems during the management of patients with poly trauma.Of 210 patients we studied,32 patients had problems at various steps and maximum problems in step Ⅲ,i.e.co-ordination between various specialties in the management of patients with poly trauma.CONCLUSION:A proper poly trauma management team and a well defined standard operative procedure are the keys to effective management of patients with poly trauma by minimizing the problems encountered.

Role of Multidetector CT in Evaluation of Polytrauma Patients

Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.

Rehabilitation nursing for an earthquake survivor with severe polytrauma:A case report and literature review

The aim of this article is to summarize the experience of rehabilitation nursing of one case of severe polytrauma caused by earthquake.The key points of the rehabilitation nursing include body posture nursing,orthopedic rehabilitation nursing,pulmonary function rehabilitation nursing,bladder rehabilitation nursing,nutritional support,and psychological rehabilitation nursing.Through the comprehensive rehabilitation nursing interventions,satisfactory outcomes were obtained,and the patient was successfully recovered and discharged after 2 months.

CT Scans in Primary Survey for Polytrauma Patients

Managing critically injured patients are challenging. Victims of major trauma often present with a host of unknowns including the exact site and nature of injury with a need for urgent diagnosis and resuscitation. It takes significant clinical expertise to detect multiple injuries and implement life or limb saving treatment within a short period of time. Conventional radiographs and focused assessment with sonography for trauma (FAST) scans are useful adjuncts to help in initial diagnosis. Conventional computer tomography (CT) investigations have been used for secondary survey in these scenarios. We reviewed the guidelines that regulate the use of CT scans in multiple injured patients in the UK. CT imaging is rapidly emerging as an adjunct to primary survey. It allows quick detection of major organ injury allowing focussed treatment whilst simultaneous initial resuscitation is underway. Availability of adequate resources is needed for widespread adaptation of this technique that involves manpower, relocation and refurbishment of the CT suites. Although it is not yet clear if using CT imaging during primary survey reduces mortality, it surely results in more organised patient care and efficient use of resources in an acute setting.

A rat model of multicompartmental traumatic injury and hemorrhagic shock induces bone marrow dysfunction and profound anemia

Background:Severe trauma is associated with systemic inflammation and organ dysfunction.Preclinical rodent trauma models are the mainstay of postinjury research but have been criticized for not fully replicating severe human trauma.The aim of this study was to create a rat model of multicompartmental injury which recreates profound traumatic injury.Methods:Male Sprague-Dawley rats were subjected to unilateral lung contusion and hemorrhagic shock(LCHS),multicompartmental polytrauma(PT)(unilateral lung contusion,hemorrhagic shock,cecectomy,bifemoral pseudofracture),or na?ve controls.Weight,plasma toll-l ike receptor 4(TLR4),hemoglobin,spleen to body weight ratio,bone marrow(BM)erythroid progenitor(CFU-GEMM,BFU-E,and CFU-E)growth,plasma granulocyte colony-stimulating factor(G-CSF)and right lung histologic injury were assessed on day 7,with significance defined as p values<0.05(*).Results:Polytrauma resulted in markedly more profound inhibition of weight gain compared to LCHS(p=0.0002)along with elevated plasma TLR4(p<0.0001),lower hemoglobin(p<0.0001),and enlarged spleen to body weight ratios(p=0.004).Both LCHS and PT demonstrated suppression of CFU-E and BFU-E growth compared to naive(p<0.03,p<0.01).Plasma G-CSF was elevated in PT compared to both na?ve and LCHS(p<0.0001,p=0.02).LCHS and PT demonstrated significant histologic right lung injury with poor alveolar wall integrity and interstitial edema.Conclusions:Multicompartmental injury as described here establishes a reproducible model of multicompartmental injury with worsened anemia,splenic tissue enlargement,weight loss,and increased inflammatory activity compared to a less severe model.This may serve as a more effective model to recreate profound traumatic injury to replicate the human inflammatory response postinjury.

Pelvic fractures in blunt trauma patients:A comparative study

BACKGROUND Pelvic fractures(PF)with concomitant injuries are on the rise due to an increase of high-energy trauma.Increase of the elderly population with age related comorbidities further complicates the management.Abdominal organ injuries are kindred with PF due to the proximity to pelvic bones.Presence of contrast blush(CB)on computed tomography in patients with PF is considered a sign of active bleeding,however,its clinical significance and association with outcomes is debatable.AIM To analyze polytrauma patients with PF with a focus on the geriatric population,co-injuries and the value of contrast blush.METHODS This retrospective cohort study included 558 patients with PF admitted to level 1 trauma center(01/2017-01/2023).Analyzed variables included:Age,sex,mechanism of injury(MOI),injury severity score(ISS),Glasgow coma scale(GCS),abbreviated injury scale(AIS),co-injuries,transfusion requirements,pelvic angiography,embolization,laparotomy,orthopedic pelvic surgery,intensive care unit and hospital lengths of stay,discharge disposition and mortality.The study compared geriatric and non-geriatric patients,patients with and without CB and abdominal co-injuries.Propensity score matching was implemented in comparison groups.RESULTS PF comprised 4%of all trauma admissions.89 patients had CB.286(52%)patients had concomitant injuries including 93(17%)patients with abdominal co-injuries.Geriatric patients compared to non-geriatric had more falls as MOI,lower ISS and AIS pelvis,higher GCS,less abdominal co-injuries,similar CB and angio-embolization rates,less orthopedic pelvic surgeries,shorter lengths of stay and higher mortality.After propensity matching,orthopedic pelvic surgery rates remained lower(8%vs 19%,P<0.001),hospital length of stay shorter,and mortality higher(13%vs 4%,P<0.001)in geriatric patients.Out of 89 patients with CB,45(51%)were embolized.After propensity matching,patients with CB compared to without CB had more pelvic angiography(71%vs 12%,P<0.001),higher embolization rates(64%vs 22%,P=0.02)and comparable mortality.CONCLUSION Half of the patients with PF had concomitant co-injuries,including abdominal co-injuries in 17%.Similarly injured geriatric patients had higher mortality.Half of the patients with CB required an embolization.

多发伤患者伤后早期多因型休克的临床研究

目的 研究多发伤患者在伤后早期多因型休克的发生情况及特征。方法 回顾性分析2020年6月-2023年3月收治于3家创伤中心的多发伤患者1 493例。收集入组患者住院期间相关资料、临床表现、实验室检验、影像学检查、并发症发生情况等,依据各休克类型的诊断标准,观察多发伤患者伤后早期多因型休克的发生情况及特征。通过t检验或χ2检验比较组间差异。结果 入组多发伤患者ISS为(24.52±7.28)分。69.86%(1043/1493,95%CI:67.5%~72.2%)的多发伤患者伴发休克,其中单因型休克占比90.89%(948/1043,95%CI:89.1%~92.6%),多因型休克占比9.11%(95/1043,95%CI:7.4%~10.9%)。共观察到6种不同病因组合的多因型休克,分别为低血容量性休克(HS)+分布性休克(DS),HS+梗阻性休克(OS),HS+心源性休克(CS),OS+CS,HS+DS+OS,HS+DS+CS,分别占41.05%、23.16%、14.74%、3.16%、11.58%、6.32%。与单因型休克患者相比,多因型休克患者的机械通气比例(77.89%vs. 34.60%)、血管活性药物使用比例(87.37%vs. 58.86%)、ICU住院时间[(15.7±6.5)dvs.(7.2±3.1)d]、病死率(37.89%vs. 9.60%)显著更多,P均<0.01。结论 多发伤患者伴发多因型休克并不罕见,该类患者伤情危重、预后不佳、病死率高。

急诊入院多发伤患者早期死亡的危险因素分析及预警模型构建

目的 分析多发伤患者急诊入院后早期死亡危险因素,构建可早期评估死亡风险的列线图预警模型。方法 回顾性分析宁夏医科大学总医院急诊科收治的785例多发伤患者,以随机数字法(3∶1)分为建模组和验证组,对建模组采用Logistics回归分析多发伤患者早期死亡的危险因素,使用R语言软件绘制列线图并评价。结果 多因素Logistics回归分析结果显示,年龄、MEWS评分、GCS评分、血糖和PT是急诊入院多发伤患者早期死亡的独立危险因素(OR值分别为1.042、1.554、0.705、1.094、1.144,均P<0.05)。构建列线图模型,结果显示预测模型具有良好区分度(AUC为0.955,95%CI:0.934~0.976),Hosmer-Lemeshow拟合优度检验P=0.828;外部验证AUC为0.942(95%CI:0.904~0.980)。校准曲线提示预测模型具有良好一致性。DCA曲线提示预测模型具有较高的净收益和临床有效性。结论 列线图模型具有良好的预测效能,为急诊入院多发伤患者的早期评估提供了良好的参考依据。

重视严重多发伤后早期多因型休克的临床诊治

多因型休克指患者伴发的休克可归因于两种及以上的不同休克类型,其在严重多发伤患者中并不罕见。目前对多因型休克的认识严重不足,一旦漏诊将导致严重不良后果。严重多发伤后伴发多因型休克的综合救治极其复杂,目前仍缺乏相应的诊疗规范与指南,各类处置措施也常相互矛盾,临床决策充满风险与挑战。本文回顾近年多因型休克的相关文献,并结合笔者最近的相关临床研究,对多因型休克的诊断与治疗进行初步阐述,以供临床参考。

Accuracy and outcome of rapid ultrasound in shock and hypotension （RUSH） in Egyptian polytrauma patients

Purpose： ＂Polytrauma＂ patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension （RUSH） significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. Methods： This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography （pan-CT） were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support （ATLS） guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. Results： The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock （64%）, followed by obstructive shock （14%）, distributive shock （12%） and cardiogenic shock （10%） respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. Conclusion： RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT.

Predictive value of focused assessment with sonography for trauma （FAST） for laparotomy in unstable polytrauma Egyptians patients

Purpose： The emergency physicians face significant clinical uncertainty when multiple trauma patients arrive in the emergency department （ED）. The priorities for assessment and treatment of polytrauma patients are established in the primary survey. Focused assessment with sonography for trauma （FAST） is very essential clinical skill during trauma resuscitation. Use of point of care ultrasound among the trauma team working in the primary survey in emergency care settings is lacking in Suez Canal University Hospitals even ultrasound machine not available in ED. This study aims to evaluate the accuracy of FAST in hemodynam- ically unstable polytraumatized patients and to determine its role as an indication of laparotomy. Methods： This study is a cross-sectional study included 150 polytrauma patients with a blunt mechanism admitted in Suez Canal University Hospital. Firstly primary survey by airway check, cervical spine securing with neck collar, maintenance of breathing/circulation and management of life threading conditions if present were conducted accordingly to ATLS （advanced trauma life support） guidelines. The patients were assessed in the primary survey using the FAST as a tool to determine the presence of intra- abdominal collection. Results： A total of 150 patients, and FAST scans were performed in all cases. The sensitivity and specificity were 92.6% and 100%, respectively. The negative predictive value was 92%, while the positive predictive value of FAST was 100%. The accuracy of FAST was 96%. Conclusion： FAST is an important method to detect intra-abdominal fluid in the initial assessment in hemodynamically unstable polytrauma patients with high accuracy.

lnterleukin-6 and interleukin-10 plasma levels and mRNA expression in polytrauma patients

Purpose： Host response to polytrauma occasionally has unpredictable outcomes. Immune response is a major factor influencing patient＇s outcome. This study evaluated the interaction of two main cytokines in immune response after major trauma, specifically interleukin-6 （IL-6） and interleukin-10 （IL-10）. Plasma level of these cytokines is determined by mRNA expression of these cytokines genes which may decide the outcome of polytrauma patients. Methods： This prospective multicenter trial held at four trauma centers enrolled 54 polytrauma patients [Injury Severity Score （ISS） ≥ 16]. Plasma levels and mRNA expression of IL-6 and IL-10 were measured for 5 days after trauma. Clinical evaluation was conducted to observe whether patients endured multiple organ dysfunction syndrome （MODS） and death. MODS evaluation was performed using sequential organ failure assessment （SOFA）. Trauma load which in this study is represented with ISS, plasma level, expression of cytokine genes and patient＇s outcome were examined with correlation test and statistical analysis. Results： The elevated IL-6/IL-10 ratio indicated increased activity of systemic inflammation response, especially pro-inflammation response which bears higher probability of progressing to MODS and death. The decline of IL-6/IL-IO ratio with heavy trauma load （1SS 〉 30） showed that compensatory anti- inflammation response syndrome （CARS） state was more dominant than systemic inflammatory response syndrome （SIRS）, indicating that malfunction and failure of immune system eventually lead to MODS and deaths. The statistical significance in plasma level of cytokines was found in the outcome group which was defined as bearing a low trauma load but mortality. Conclusion： The pattern of cytokine levels in inflammation response has great impact on the outcome of polytrauma patients. Further study at the genetic level is needed to investigate inflammation process which may influence patient＇s outcome.

Orthopaedic management in the polytrauma patient

The past century has seen many changes in the management of the polytraumatized orthopaedic patient.Early recommendations for non-operative treatment have evolved into early total care(ETC)and damage control orthopaedic(DCO)treatment principles.These principles force the treating orthopaedist to take into account multiple patient parameters including hypothermia,coagulopathy and volume status before deciding upon the operative plan.This requires a multidisciplinary approach involving critical care physicians,anesthesiologists and others.

The influence of metabolic imbalances and oxidative stress on the outcome of critically ill polytrauma patients: a review

The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.

Cervical spine clearance in obtunded patients after severe polytrauma

Objective： To provide clinicians with data supporting three different clearance techniques in the obtunded patients after severe polytrauma. Methods： This study gave an overview of the available and pertinent literature regarding cervical spine clearance in obtunded patients after severe polytrauma. Results： Currently, there were three accepted techniques for clearance of the cervical spine in obtunded patients after severe polytrauma. Each of these methods has advantages and disadvantages to both of the patients and the clinicians, Conclusions： There are continuous improvements in both computed tomography （CT） and magnetic resonance imaging （MRI） techniques that increase their sensitivities. The continued use of plain radiographs is called into question with respect to cost and time requirements. An algorithmic approach to the evaluation of the cervical spine in the obtunded patients will lead to fewer missed injuries.

基于急诊外科医生主导的急诊床旁超声改良扩大创伤重点超声评估方案在胸腹多发创伤患者中的应用效果

目的:探讨基于急诊外科医生主导的急诊床旁超声改良扩大创伤重点超声评估方案在胸腹多发创伤患者中的应用效果。方法:选取2022年1月—2023年11月东莞市黄江医院急诊科收治的胸腹多发创伤患者60例作为研究对象,采用随机数字表法分为对照组与观察组,各30例。对照组应用常规超声方案,观察组应用基于急诊外科医生主导的急诊床旁超声改良扩大创伤重点超声评估方案。将手术探查结果作为“金标准”,比较两组各部位损伤检出率、总检出率及急救效率。结果:两组各部位损伤检出及总检出率比较,差异无统计学意义(P>0.05)。观察组入院至完成超声检查时间、完成超声检查至手术时间、住院时间短于对照组,抢救成功率高于对照组,差异有统计学意义(P<0.05)。结论:基于急诊外科医生主导的急诊床旁超声改良扩大创伤重点超声评估方案在胸腹多发创伤患者中的应用效果显著,可提高急救效率,且不影响损伤检出率。

The Utility of the Galea in Scalp Reconstruction

Total scalp avulsion is a time-sensitive, catastrophic injury requiring quick, complex decision-making. Traditionally, these injuries were treated with split-thickness skin grafts. With advancements in microsurgery, treatments evolved to scalp replantation, becoming the standard of care in scalp reconstruction. Although the integrity of the scalp’s blood vessels is pivotal for successful replantation, the authors believe that scalp replantation should be considered at all costs. In the presented case, a 54-year-old female presented to the emergency room following an incident with an auger that completely avulsed her scalp. She was taken back to the operating room, where scalp replantation was performed. Following replantation, scalp necrosis led to serial debridings in the operating room, and eventually, all of the scalp was debrided down to healthy tissue. Surprisingly, the galea survived despite this, which provided a healthy base for skin grafts. Before definitive coverage was placed, it was decided to utilize a bilaminar acellular dermal matrix along with negative pressure wound therapy to create a more robust bed of granulation tissue. After three weeks of this treatment plan, the patient returned to the operating room, where a healthy, viable bed of granulating tissue was revealed beneath the dermal matrix. Split-thickness skin grafts were taken from her thighs bilaterally and sewn together in a quilt-like fashion to cover the wound bed. The entirety of the graft healed without complication except for one small area that required full-thickness skin grafting in an outpatient setting. Even though the replantation ultimately failed, it allowed the galea to survive, which saved the patient from undergoing a free tissue transfer and allowed her scalp to be reconstructed with split-thickness skin grafts. Even in the setting of polytrauma, the authors hope that anyone treating a scalp avulsion would consider scalp replantation at all costs.

骨科严重多发伤患者预后不良的危险因素及急救措施探讨

目的分析骨科严重多发伤患者预后不良的危险因素,进一步为行之有效的针对性急救措施提供指导依据。方法选取2021年1月31日—2022年5月31日于唐山市第二医院医院骨科就诊的严重多发伤患者600例作为研究对象,根据生存情况分为预后不良(非存活)组和预后良好(存活)组,Logistic回归分析严重多发伤患者预后不良因素,并进行预测及真实性排序。结果本研究纳入的600例患者道路交通伤、高处坠落伤是常见类型,占损伤人数的59.00%、26.33%。其次,重物砸压伤9.00%,刀刺殴击伤3.50%及其他机制伤2.17%;胸部受伤者70.00%,头部66.83%,四肢41.83%,腹部37.50%,面部24.67%,颈部14.83%,每例患者平均受累部位(2.62±0.87)处,其中胸部、头部及四肢是意外事故中较易受损部位;平均住院时间(21.58±11.69)d。71.83%患者发生全身炎症反应综合征(SIRS),32.17%患者并发感染致脓毒症,20.83%患者出现多器官功能衰竭或不全,20.67%患者发生失血性休克,最终有10.83%患者预后不良。患者并发SIRS、失血性休克、多器官功能障碍综合征(MODS)、急性呼吸窘迫综合征(ARDS)、并发持续性炎症-免疫抑制-分解代谢综合征(PICS)、格拉斯哥昏迷(GCS)评分、受伤至急诊时间是严重多发伤患者预后不良的独立危险因素,而血浆纤维蛋白原(Fib)、应用损伤控制外科理念是其保护因素;各因素对预后不良预测的真实性从高到低分别为受伤至急诊时间、Fib、GCS评分、并发PICS、并发SIRS、应用损伤控制外科理念、MODS、失血性休克、ARDS。结论并发SIRS、失血性休克、MODS、ARDS、并发PICS、GCS评分、受伤至急诊时间是严重多发伤患者预后不良的独立危险因素,而Fib、应用损伤控制外科理念是其保护因素,构建预测模型,加强早期预警有利于改善预后。