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严重创伤患者急诊预后预测模型及评分工具的构建

Construction of a prognostic prediction model and scoring tool for severe trauma patients in the emergency department

摘要:

目的:利用严重创伤患者的生理指标构建急诊预后预测模型及评分工具,对其临床应用效果进行验证,为创伤患者在急诊的早期病情评估提供参考。方法:本研究是回顾性研究,采用整群抽样法,收集2019年9月至2020年11月于苏州大学附属第一医院急诊科就诊的符合纳入排除标准的严重创伤患者资料,根据患者的预后按7∶3的比例根据预后情况分层随机分配为建模组与验证组。对建模组的资料进行Logistic回归分析构建预后预测模型,并将预测模型转化为简易评分工具,通过验证组和为期2个月的前瞻性数据验证对其应用效果进行评价。并将本研究构建的简易评分工具预测效能与目前临床使用的修正创伤评分(revised trauma score, RTS)和损伤严重度评分(injury severity score, ISS)比较。结果:本研究最终纳入863例患者资料,其中建模组604例,验证组259例。模型共纳入收缩压、脉搏血氧饱和度、意识状态(AVPU评分)3项指标,其预测严重创伤患者急诊死亡的受试者操作曲线下面积(the area under receiver operating cure, AUC)为0.938。模型简化评分工具的AUC为0.933,最佳截断值为5分,敏感度86.7%,特异度94.2%;验证组的AUC为0.885,敏感度83.3%,特异度93.7%;前瞻性验证的AUC为0.919,敏感度100%,特异度76.7%。RTS和ISS的AUC分别为0.800和0.833,RTS的AUC低于本研究构建简化评分工具( P<0.05)。 结论:本预测模型及简化评分工具对严重创伤患者急诊预后的预测效能优于RTS,具有较高的分辨度,适合急诊医护工作者对严重创伤患者病情严重程度的评估。

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abstracts:

Objective:To construct the prognostic prediction model and scoring tool by using severe trauma patients’ physiological indicators on admission, and to verify the clinical application effect and provide a reference for the early evaluation of severe trauma patients.Methods:This study was a retrospective study which adopted cluster sampling. Patients who met the inclusion and exclusion criteria in the emergency department of the First Affiliated Hospital of Soochow University from September 2019 to November 2020 were included. Patients were randomly assigned into the modeling group and the validation group in a ratio of 7:3 based on their outcome in the emergency department. Logistic regression analysis was performed to construct a prediction model, which was simplified as a scoring tool. The model was verified by using validation group and two months’ prospective validation. The efficiency of the simplified scoring tool was compared with that of the revised trauma score (RTS) and the injury severity score (ISS).Results:Totally 863 patients were included in this study, including 604 patients in the modeling group and 259 patients in the validation group. The model included systolic blood, SpO 2 and AVPU score. The AUC for predicting the death of severe trauma patients was 0.938. The AUC of the prediction model was 0.933, the best cut-off point was 5, the sensitivity was 86.7%, the specificity was 94.2%; the AUC of the validation was 0.885, the sensitivity was 83.3%, the specificity was 93.7%; and the AUC of prospective validation was 0.919, the sensitivity was 100%, and the specificity was 76.7%. The AUC of the RTS and ISS were 0.800 and 0.833, respectively. The AUC of RTS was lower than that of the simplified scoring tool constructed in this research. Conclusions:The prediction model and simplified scoring tool are better than RTS in predicting the outcome of emergency severe trauma patients, which are convenient for emergency medical staff to evaluate the severity of trauma patients.

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作者: 李林芳 [1] 胡化刚 [1] 徐峰 [2] 邱兰峰 [2] 陈都 [2] 李小勤 [2]
期刊: 《中华急诊医学杂志》2022年31卷5期 592-597页 ISTICPKUCSCD
栏目名称: 创伤
DOI: 10.3760/cma.j.issn.1671-0282.2022.05.004
发布时间: 2022-07-31
基金项目:
2022年度苏州大学附属第一医院护理院级科研项目 The Nursing Research Project of the First Affiliated Hospital of Soochow University in 2022
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