Pre-hospital application of REBOA for life-threatening hemorrhage

Dear Editor,Most battlefield casualties occur prior to the arrival of medical facilities.Uncontrollable hemorrhage accounts for more than 90%of those potentially survivable battlefield casualties[1].In both military and civilian conditions,non-compressible torso hemorrhage always caused rapid exsanguination and high mortality rates before definitive treatment[2].More than half of the deaths due to non-compressible torso hemorrhage occur before hospital care can be provided[2].Therefore,early and rapid pre-hospital hemorrhage control is essential to reduce mortality.

Systemic analysis of pre-hospital trauma emergency treatment in Zhengzhou

Objective: To analyze the data of pre-hospital emergency treatment in zhengzhou from 2007 to 2016, and evaluate the current situation of pre-hospital trauma emergency treatment, in order to provide a scientific basis for effective use of first aid resources and enhance success rate of trauma emergency treatment. Methods: Retrospective analysis was conducted based on pre-hospital emergency resources of Zhengzhou Emergency Medical Rescue Center from 2007 to 2016. Results: The total number of pre-hospital emergency treatment cases was 9305687 from 2007 to 2016 in Zhengzhou, of which 418882 were trauma cases. The top five causes of injury were traffic accident injury, cutting injury, beating injury, crushing injury and falling injury. The top five emergency treatments used were oxygen, hemostasis, dressing and fixation, fluid supplementation, analgesics and sputum aspiration. According to different directions of diagnosis, the pre-hospital emergency patients were divided into four groups:emergency treatment group, emergency observation group, admission to general ward group and admission to ICU group. There was no statistical difference in the ages among the four groups (P>0.05). There were significantly statistical differences in gender composition among the four groups, with more males than females (P<0.01). Significant statistical differences also showed in CRAMS scores among the four groups (P<0.01). Before and after the training of primary trauma care, there was no significant difference in the constituent ratio of the trauma (P>0.05), but the mortality of the trauma, the average arrival time, and the mean treatment time were significantly different (P<0.01). Conclusions: The number of pre-hospital emergency trauma patients increased year by year, but the constituent ratio changed little. CRAMS score is important for the patients triage. Through the training of primary trauma care, the constituent ratio of death was reduced, and the average treatment time was shortened.

French pre-hospital trauma triage criteria:Does the “prehospital resuscitation” criterion provide additional benefit in triage?

AIM:To evaluate the performance of the specific French Vittel "Pre-Hospital(PH) resuscitation" criteria in selecting polytrauma patients during the pre-hospital stage and its potential to increase the positive predictive value(PPV) of pre-hospital trauma triage.METHODS: This was a monocentric prospective cohort study of injured adults transported by emergency medi-cal service to a trauma center. Patients who met any of the field trauma triage criteria were considered "triage positive". Hospital data was statistically linked to prehospital records. The primary outcome of defining a "major trauma patient" was Injury Severity Score(ISS) > 16. RESULTS: There were a total of 200 injured patients evaluated over a 2 years period who met at least 1 triage criterion. The number of false positives was 64 patients(ISS < 16). The PPV was 68%. The sensitivity and the negative predictive value could not be evaluated in this study since it only included patients with positive Vittel criteria. The criterion of "PH resuscitation" was present for 64 patients(32%),but 10 of them had an ISS < 16. This was statistically significant in correlation with the severity of the trauma in univariate analysis(OR = 7.2; P = 0.005; 95%CI: 1.6-31.6). However,despite this correlation the overall PPV was not significantly increased by the use of the criterion "PH resuscitation"(68% vs 67.8%).CONCLUSION: The criterion of "pre-hospital resuscitation" was statistically significant with the severity of the trauma,but did not increase the PPV. The use of "prehospital resuscitation" criterion could be re-considered if these results are confirmed by larger studies.

Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

Three predictive scores compared in a retrospective multicenter study of nonunion tibial shaft fracture

BACKGROUND Delayed union,malunion,and nonunion are serious complications in the healing of fractures.Predicting the risk of nonunion before or after surgery is challenging.AIM To compare the most prevalent predictive scores of nonunion used in clinical practice to determine the most accurate score for predicting nonunion.METHODS We collected data from patients with tibial shaft fractures undergoing surgery from January 2016 to December 2020 in three different trauma hospitals.In this retrospective multicenter study,we considered only fractures treated with intramedullary nailing.We calculated the tibia FRACTure prediction healING days(FRACTING)score,Nonunion Risk Determination score,and Leeds-Genoa Nonunion Index(LEG-NUI)score at the time of definitive fixation.RESULTS Of the 130 patients enrolled,89(68.4%)healed within 9 months and were classified as union.The remaining patients(n=41,31.5%)healed after more than 9 months or underwent other surgical procedures and were classified as nonunion.After calculation of the three scores,LEG-NUI and FRACTING were the most accurate at predicting healing.CONCLUSION LEG-NUI and FRACTING showed the best performances by accurately predicting union and nonunion.

Delta shock index predicts injury severity,interventions,and outcomes in trauma patients:A 10-year retrospective observational study

BACKGROUND Most trauma occurs among young male subjects in Qatar.We examined the predictive values of the delta shock index(DSI),defined as the change in the shock index(SI)value from the scene to the initial reading in the emergency unit(i.e.,subtracting the calculated SI at admission from SI at the scene),at a Level 1 trauma center.AIM To explore whether high DSI is associated with severe injuries,more interventions,and worse outcomes[i.e.,blood transfusion,exploratory laparotomy,ventilator-associated pneumonia,hospital length of stay(HLOS),and in-hospital mortality]in trauma patients.METHODS A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021.Patients were grouped based on DSI as low(≤0.1)or high(>0.1).Data were analyzed and compared usingχ2 and Student’s t-tests.Correlations between DSI and injury severity score(ISS),revised trauma score(RTS),abbreviated injury scale(AIS),Glasgow coma scale(GCS),trauma score-ISS(TRISS),HLOS,and number of transfused blood units(NTBU),were assessed using correlation coefficient analysis.The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI.Logistic regression analysis was performed to identify predictors of mortality.RESULTS This analysis included 13212 patients with a mean age of 33±14 years,and 24%had a high DSI.Males accounted for 91%of the study population.The trauma activation level was higher in patients with a high DSI(38%vs 15%,P=0.001).DSI correlated with RTS(r=-0.30),TRISS(r=-0.30),NTBU(r=0.20),GCS(r=-0.24),ISS(r=0.22),and HLOS(r=0.14)(P=0.001 for all).High DSI was associated with significantly higher rates of intubation,laparotomy,ventilator-associated pneumonia,massive transfusion activation,and mortality than low DSI.For mortality prediction,a high DSI had better specificity,negative predictive value,and negative likelihood ratio(77%,99%,and 0.49%,respectively).After adjusting for age,emergency medical services time,GCS score,and ISS,multivariable regression analysis showed that DSI was an independent predictor of mortality(odds ratio=1.9;95%confidence interval:1.35-2.76).CONCLUSION In addition to sex-biased observations,almost one-quarter of the study cohort had a higher DSI and were mostly young.High DSI correlated significantly with the other injury severity scores,which require more time and imaging to be ready to use.Therefore,DSI is a practical,simple bedside tool for triaging and prognosis in young patients with trauma.

Reliability of the ocular trauma score for the predictability of traumatic and post-traumatic retinal detachment after open globe injury

AIM: To elucidate the question of whether the ocular trauma score(OTS) and the zones of injury could be used as a predictive model of traumatic and post traumatic retinal detachment(RD) in patients with open globe injury(OGI).METHODS: A retrospective observational chart analysis of OGI patients was performed. The collected variables consisted of age, date, gender, time of injury, time until repair, mechanism of injury, zone of injury, injury associated vitreous hemorrhage, trauma associated RD, post traumatic RD, aphakia at injury, periocular trauma and OTS in cases of OGI. RESULTS: Totally 102 patients with traumatic OGI with a minimum of 12 mo follow-up and a median age at of 48.6 y(range: 3-104 y) were identified. Final best corrected visual acuity(BCVA) was independent from the time of repair, yet a statistically significant difference was present between the final BCVA and the zone of injury. Severe trauma presenting with an OTS score Ⅰ(P<0.0001) or Ⅱ(P<0.0001) revealed a significantly worse BCVA at last follow up when compared to the cohort with an OTS score >Ⅲ. OGI associated RD was observed in 36/102 patients(35.3%), whereas post traumatic RD(defined as RD following 14 d after OGI) occurred in 37 patients(36.3%). OGI associated RD did not correlate with the OTS and the zone of injury(P=0.193), yet post traumatic RD correlated significantly with zone Ⅲ injuries(P=0.013). CONCLUSION: The study shows a significant association between lower OTS score and zone Ⅲ injury with lower final BCVA and a higher number of surgeries, but only zone Ⅲ could be significantly associated with a higher rate of RD.

Application of pediatric ocular trauma score in pediatric open globe injuries

AIM:To evaluate the predictive value of pediatric penetrating ocular trauma score(POTS)on the visual outcome in children with open globe injury.METHODS:A retrospective study in 90 children(60 males and 30 females)aged 1-15 y(average,7.48±2.86 y)with penetrating ocular trauma was performed.Each patient’s POTS was calculated.The effects of POTS on final visual acuity(FVA)were examined.Correlation between factors affecting POTS and the FVA was established.RESULTS:All patients presented with single-eye trauma.The follow-up time was 3-21 mo(average,10.23±3.54 mo).Among the 90 cases of penetrating wounds,71 eyes(78.89%)were injured in Zone I(wound involvement limited to the cornea,including the corneoscleral limbus),17 eyes(18.89%)were injured in Zone II(wound involving the sclera and no more posterior than 5 mm from the corneoscleral limbus),and 2 eyes(2.22%)were injured in Zone III(wound involvement posterior to the anterior 5 mm of the sclera).Analysis of POTS and FVA showed important correlation between them(r=0.414,P=0.000).Initial visual acuity(P=0.00),age(P=0.02),injury location(P=0.002),traumatic cataract(P=0.00),vitreous hemorrhage(P=0.027),retinal detachment(P=0.003),and endophthalmitis(P=0.03)were found to be statistically significant factors for the FVA outcome.CONCLUSION:Ocular trauma presents serious consequences and poor prognosis in children.The POTS may be a reliable prognostic tool in children with open globe injury.

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score(OTS) and Pediatric Ocular Trauma Score(POTS) for closed and open globe injuries in the pediatric group.METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted.Medical records were collected,and injuries were classified using Birmingham Eye Trauma Terminology System(BETTS).The predictive value and applicability of both OTS and POTS to final visual acuity(VA) were analyzed.RESULTS: Of 84 patients,59(70.2%) presented with closed globe injuries(CGI) and 25(29.8%) with open globe injuries(OGI).The mean of initial VA was 0.832±0.904 log MAR.OTS and POTS was calculated.Initial VA(P<0.001) and traumatic cataract(P<0.001) were significantly associated with visual outcome,followed by organic/unclean wound (P=0.001),delay of surger y(P=0.001),iris prolapse(P=0.003),and globe rupture(P=0.008).A strong correlation between OTS and POTS and final VA(r=-0.798,P<0.001;r=-0.612,P<0.001) was found.OTS was more applicable in all age group of pediatric and in contrast to POTS,it was designed for 0-15 years old.POTS requires eleven parameters and OTS six parameters.Even though initial VA was not available,we could still calculate into POTS equation.CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.

Impact of lockdown policies during the COVID-19 outbreak on a trauma center of a tertiary hospital in China

BACKGROUND Coronavirus disease 2019(COVID-19)is a major and costly public health emergency.AIM To investigate the impact of China’s lockdown policies during the COVID-19 outbreak on the level I trauma center of a tertiary comprehensive hospital of Traditional Chinese Medicine.METHODS All patients admitted to our trauma center during a lockdown in 2020 and the same period in 2019 were enrolled.We collected data on demographics,daily visits,injury type,injury mechanism,injury severity score,and patient management for comparative analysis.RESULTS The total number of patients in the trauma center of our hospital decreased by 50.38%during the COVID-19 Lockdown in 2020 compared to the same period in 2019.The average number of trauma visits per day in 2019 was 47.94,compared to 23.79 in 2020.Comparing the patients’demographic data,loss of employment was the most predominate characteristic in 2020 compared to 2019,while there was no significant difference in gender,age,and marital status between both periods.During the lockdown period,the proportion of traffic accident-related injuries,injuries due to falls greater than 1.5 m,and mechanical injuries decreased significantly,whereas the proportion of injuries caused by falls less than 1.5 m,cuts,assault,bites,and suicidal tendencies and other injuries increased relatively.In addition,the proportion of patients with minor injuries increased and serious injuries decreased during the lockdown.The hospitalization rate increased significantly,and there was no significant difference in emergency surgery and death rates.CONCLUSION The lockdown policies during the COVID-19 outbreak significantly altered the number and mechanism of traumatic events in our hospital,which can be monitored regularly.Our results suggest that mandatory public health prevention and control measures by the government can reduce the incidence of traumatic events and the severity of traumatic injuries.Emergency surgery and mortality rates remain high,increased because of factors such as family injury and penetrating injury,and hospitalization rates have increased significantly.Therefore,our trauma center still needs to be fully staffed.Finally,from the perspective of the injury mechanism,indoor trauma is a major risk during a lockdown,and it is particularly important to develop prevention strategies for such trauma to reduce the medical burden of the next catastrophic epidemic.

Initial suction drainage decreases severe postoperative complications after pancreatic trauma:A cohort study

BACKGROUND Few studies have addressed the question of which drain types are more beneficial for patients with pancreatic trauma(PT).AIM To investigate whether sustained low negative pressure irrigation(NPI)suction drainage is superior to closed passive gravity(PG)drainage in PT patients.METHODS PT patients who underwent pancreatic surgery were enrolled consecutively at a referral trauma center from January 2009 to October 2021.The primary outcome was defined as the occurrence of severe complications(Clavien-Dindo grade≥Ⅲb).Multivariable logistic regression was used to model the primary outcome,and propensity score matching(PSM)was included in the regression-based sensitivity analysis.RESULTS In this study,146 patients underwent initial PG drainage,and 50 underwent initial NPI suction drainage.In the entire cohort,a multivariable logistic regression model showed that the adjusted risk for severe complications was decreased with NPI suction drainage[14/50(28.0%)vs 66/146(45.2%);odds ratio(OR),0.437;95%confidence interval(CI):0.203-0.940].After 1:1 PSM,44 matched pairs were identified.The proportion of each operative procedure performed for pancreatic injury-related and other intra-abdominal organ injury-related cases was comparable in the matched cohort.NPI suction drainage still showed a lower risk for severe complications[11/44(25.0%)vs 21/44(47.7%);OR,0.365;95%CI:0.148-0.901].A forest plot revealed that NPI suction drainage was associated with a lower risk of Clavien-Dindo severity in most subgroups.CONCLUSION This study,based on one of the largest PT populations in a single high-volume center,revealed that initial NPI suction drainage could be recommended as a safe and effective alternative for managing complex PT patients.

脑外伤后睡眠障碍患者医患护三位一体实施的应用效果

目的:以脑外伤以后出现睡眠障碍的患者为研究对象,分析医患护三位一体的实施效果。方法:选取2023年1月至2023年12月福建省立医院南院收治的脑外伤且均伴有不同程度的睡眠障碍患者76例作为研究对象,按照系统随机化法分为对照组和观察组,每组38例。对照组采取常规护理,观察组应用医患护三位一体,对比干预效果,评估指标包含睡眠质量、心理状态、疾病不确定感。结果:护理前,2组患者睡眠质量、心理状态以及疾病不确定感评分比较,差异无统计学意义(P>0.05)。护理后,睡眠质量评分均降低,且观察组较对照组低(P<0.05);护理后,观察组HAMA、HAMD评分低于对照组(P<0.05),观察组疾病不确定感低于对照组(P<0.05)。结论:予以脑外伤后睡眠障碍患者医患护三位一体干预对于提高睡眠质量、改善心理状态具有突出效果,有利于减轻患者疾病不确定感,具有较高借鉴价值。

严重多发外伤患者并发脓毒症的危险因素及风险预测模型构建

目的分析严重多发外伤患者并发脓毒症的危险因素,并建立风险预测模型。方法收集南阳市第一人民医院2021年1月至2022年12月收治的120例严重多发外伤患者临床资料进行回顾性分析,依据是否并发脓毒症分为脓毒症组41例与非脓毒症组79例。采用logistic回归分析影响严重多发外伤患者并发脓毒症的危险因素,依据回归分析结果构建风险预测模型,并计算一致性指数(C-index)判断模型区分度。结果脓毒症组年龄、中性粒细胞与淋巴细胞计数比值(NLR)、活化部分凝血活酶时间(APTT)、创伤严重程度评分(ISS)、序贯器官衰竭(SOFA)评分均大于非脓毒症组,机械通气患者占比高于非脓毒症组,差异有统计学意义(P<0.05);经logistic回归分析显示,NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的独立危险因素(OR>1,P<0.05);绘制列线图构建严重多发外伤患者并发脓毒症的风险预测模型,验证模型区分度显示C-index值=0.908,区分度良好;绘制标准曲线显示,校准曲线和Y-X直线紧密贴合,模型准确度良好。结论NLR、APTT、ISS评分为严重多发外伤患者并发脓毒症的危险因素,基于上述因素构建的风险预测模型对严重多发外伤患者并发脓毒症具有较高预测价值。

人员易损性分析研究进展及应用综述

人员是战场中的核心要素,是最易损、最复杂的对象之一,其易损性研究涉及力学、数学、统计学、医学、生物学等多学科交叉,研究难度大,但对于开展杀伤效能评估、防护效能、战伤救治等具有重要价值。通过总结不同目标易损性分析的文献,提出损伤评分及杀伤判据是人员易损性分析中的两个重要环节。回顾了人员损伤评分的研究现状,重点介绍了4种常用评分方法(简明创伤评分、损伤严重度评分、校正损伤严重度指数、军用战伤评分)及应用情况;给出了典型战场环境中冲击波、投射物、冲击振动、热4种主要杀伤元对无防护人员损伤的研究动态、评估模型、杀伤判据。分析了基于数字化人体模型开展的人员易损性分析应用技术,探讨了易损性分析结果的主要应用场景,分析了该领域可能的主要发展方向。所得结果可为人员易损性研究提供重要参考。

以简明损伤定级标准与创伤严重程度评分为基础的分级护理在急诊创伤骨折患者中的应用效果

目的:探讨以简明损伤定级标准与创伤严重程度(AIS-ISS)评分为基础的分级护理在急诊创伤骨折患者中的应用效果,为临床护理提供依据。方法:选取2021年1月—2022年12月福建医科大学附属第一医院急诊科收治的100例创伤骨折患者作为研究对象,采用随机数表法将其分为对照组与试验组,每组各50例。对照组患者采用急诊常规护理,试验组患者在急诊常规护理基础上实施以AIS-ISS评分为基础的分级护理。比较两组患者的救治效果、护理服务质量及护理满意度情况。结果:试验组患者评估伤情时间、入院检查时间、有效救治时间、住院时间均明显短于对照组,救治成功率高于对照组,并发症发生率低于对照组,差异有统计学意义(t=13.205、7.815、10.289、10.978,χ^(2)=7.527、5.005,P<0.05)。试验组患者感知护理服务质量评价量表中各维度评分均明显高于对照组,差异有统计学意义(t=6.941、6.661、6.836、8.971,P<0.05)。试验组患者护理满意度量表中各维度评分及总分均明显高于对照组,差异有统计学意义(t=6.350、12.034、9.176、7.509、16.005,P<0.05)。结论:以AIS-ISS评分为基础对急诊创伤骨折患者实施分级护理,能够提高护理服务质量,缩短患者救治时间,提高救治成功率,改善患者临床结局,进而提升护理满意度。

修正创伤评分指导下多学科团队合作创伤团队一体化急救护理在严重多发性创伤休克患者救护中的应用

目的:探究修正创伤评分(RTS)指导下多学科团队合作(MDT)创伤团队一体化急救护理在严重多发性创伤休克患者救护中的应用效果。方法:选取2017年1月—2023年6月肇庆市第一人民医院收治的严重多发性创伤休克患者80例作为研究对象,采用随机数字表法分为观察组和对照组,各40例。对照组给予常规急救护理干预,观察组给予RTS指导下MDT创伤团队一体化急救护理干预。比较两组患者急救状况、急救结局、急救护理质量评分。结果:观察组入院至确诊、入院至手术、入院至病房时间及住院时间均短于对照组,差异有统计学意义(P<0.05);观察组急救成功率高于对照组,观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05);观察组护理服务、健康教育、岗位职责、信息沟通、候诊环境评分高于对照组,差异有统计学意义(P<0.001)。结论:RTS指导下MDT创伤团队一体化急救护理干预应用于严重多发性创伤休克患者中,能够快速评估患者创伤情况,缩短急救时间,改善患者急救结局,提高急救护理质量。

开放性眼外伤患者临床特征及视力影响因素分析

目的:总结西北地区开放性眼外伤住院患者的临床特征、预后视力影响因素,并探讨眼外伤评分(OTS)在开放性眼外伤中的应用。方法:回顾性分析2021-06/2023-06在西京医院收住院的91例91眼开放性眼外伤患者的临床数据资料。对年龄、就诊时间、初视力、外伤分区等因素进行视力预后的相关性分析,并探讨不同OTS评分分级与预后视力的关系。结果:单因素分析显示年龄(0-20岁)、就诊时间(<24 h)、初始视力、外伤分区、外伤类型(穿通伤)、前房积血、玻璃体积血与预后视力有关(均P<0.1);多因素Logistic回归分析显示初始视力及就诊时间(<24 h)是危险因素(均P<0.05)。不同OTS评分分级与预后视力有显著相关性(r s=0.639,P<0.001)。结论:开放性眼外伤患者应尽早及时诊治,其预后视力主要影响因素有年龄、就诊时间、初始视力、外伤分区、外伤类型、前房积血及玻璃体积血。OTS评分在开放性眼外伤预后视力评估中有良好的应用价值。

基于ROC曲线的几种创伤严重程度评估工具对老年创伤患者院内死亡预测效果的对比研究

目的比较新损伤严重程度评分(NISS)、指数型损伤严重程度评分(EISS)、创伤和损伤严重程度评分(TRISS)及老年创伤结局评分(GTOS)用于预测老年创伤患者院内死亡风险的效果。方法回顾性追溯选定时间跨度(2019年1月至2022年12月)内所有经急诊入院的老年创伤患者(共197例)的临床资料,计算并统计上述4种创伤严重程度评估工具的结果并绘制受试者工作特征(ROC)曲线,分析比较各评估工具的ROC曲线下面积(AUC)、约登指数以及敏感度、特异度,并以传统的损伤严重程度评分(ISS)的结果作为对照。结果4种改进型评估工具的预测效果均优于传统评估工具(ISS评分)。其中,TRISS评分的AUC、约登指数、敏感度和特异度均最高;NISS评分的AUC和约登指数均最低;GTOS评分的AUC和敏感度与EISS评分较为接近,但约登指数和特异度均显著高于EISS评分。结论TRISS评分在急诊老年创伤患者死亡风险预测评估方面的综合应用效果最佳,GTOS评分预测效果不及TRISS,但评估计算过程更简单,其改进和优化值得进一步探索。

急诊创伤并发创伤性凝血病患者预后的风险预测模型构建与验证

目的探究急诊创伤并发创伤性凝血病(TIC)患者预后的影响因素,并构建风险预测模型。方法本研究为回顾性研究,收集2021年1月至2023年12月医院收治的246例急性创伤并发TIC患者临床资料,根据7∶3比例将患者分为训练集(n=172)和验证集(n=74),比较患者临床资料,以明确两组的可比性。训练集患者根据28 d内存活情况分为死亡组(n=60)和存活组(n=112),比较两组临床资料,将差异有统计学意义的变量进行Cox回归分析,得到急诊创伤并发TIC患者预后的可能影响因素,基于Cox回归分析结果构建急诊创伤并发TIC患者预后的风险预测模型,并对模型预测效能进行内部验证。结果训练集和验证集患者临床资料差异无统计学意义(P>0.05)。训练集中死亡组患者入院时损伤严重程度(ISS)评分≥25分、确诊TIC时低体温、未使用氨甲环酸治疗占比高于存活组,外周血血小板、血浆纤维蛋白原水平低于存活组,血清C-反应蛋白、血浆乳酸水平高于存活组,差异有统计学意义(均P<0.05)。Cox回归分析结果显示,入院时ISS评分≥25分、确诊TIC时低体温、血浆纤维蛋白原水平低、血浆乳酸水平高均可能为急诊创伤并发TIC患者死亡的独立危险因素(P<0.05)。绘制决策曲线发现,基于急诊创伤并发TIC患者预后影响因素构建风险预测模型,风险阈值在0.00~1.00范围内,模型临床净获益率始终大于0,最大净获益率为0.332;绘制列线图将风险预测模型可视化,结果显示,模型预测急诊创伤并发TIC患者死亡的C-index为0.820(95%CI 0.776~0.864),模型辨别度良好;校准曲线趋近于理想曲线,提示模型预测概率与实际概率具有良好的一致性;内部验证结果显示,预测模型预测急诊创伤并发TIC患者死亡的曲线下面积为0.958(95%CI 0.918~0.999),已建立的预测模型在验证集同样具有良好的预测效能。结论入院时ISS评分、确诊TIC时低体温情况、血浆纤维蛋白原、血浆乳酸均可能是急诊创伤并发TIC患者预后(生存状况)的影响因素,基于上述因素构建的风险预测模型对患者死亡风险有较好的预测价值。

血栓弹力图最大振幅评价重症创伤患者预后及其影响因素的分析

目的研究血栓弹力图(TEG)最大振幅(MA)评价重症创伤患者预后的作用及其影响因素。方法回顾性分析2020年07月到2023年07月我院急诊科和ICU收治的损伤严重度评分(ISS)评分≥16的重度创伤患者112例。根据TEG的MA值将患者分为MA≥50 mm组(71例)和MA<50 mm组(41例),并对两组患者的凝血酶⁃抗凝血酶复合物(TAT)、组织纤溶酶原激活物⁃纤溶酶原激活物抑制剂⁃1复合物(t⁃PAIC)、纤溶酶⁃α2纤溶酶抑制物复合物(PIC)、纤维蛋白原(FIB)、血小板(PLT)计数和ISS评分指标进行统计分析。结果与MA≥50 mm组相比,MA<50 mm组患者TAT、PIC、t⁃PAIC和ISS评分均明显升高(P<0.05或P<0.01);FIB和PLT计数明显降低(P<0.01)。相关性分析结果显示,MA与tPAIC、TAT、PLT计数和ISS评分等指标相关(P<0.05),且与PIC和FIB相关度较高(0.4<r<0.7,P<0.05)。MA≥50 mm组重症创伤患者的28 d死亡率(26.73%)明显低于PLT计数≥100×10^(9)/L组(44.44%)(P<0.05);MA<50 mm组重症创伤患者的28 d死亡率(75.61%)明显高于PLT计数<100×10^(9)/L组(45.00%)(P<0.01)。ROC曲线显示MA预测重症创伤患者存活率的曲线下面积(AUC)为0.776,明显高于PLT计数预测重症创伤患者存活率的AUC(0.563)(P<0.01)。结论TEG的MA能有效评价重症创伤患者的预后,且与创伤严重程度有关。