Preliminary establishment and evaluation of prognostic warning scoring system for severe trauma

Ke LI; Yinjie ZHAO; Xiao HOU; Haoran ZHU; Qiang XIANG; Minghua LIU

doi:10.16016/j.2097-0927.202203113

您当前的位置：

首页 >

文章列表页 >

Preliminary establishment and evaluation of prognostic warning scoring system for severe trauma

Clinical Medicine | 更新时间：2026-01-09

- Preliminary establishment and evaluation of prognostic warning scoring system for severe trauma
- Journal of Army Medical University Vol. 44, Issue 17, Pages: 1728-1735(2022)
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院急诊医学科
  2.830000 乌鲁木齐，新疆军区总医院急诊医学科
- 作者简介：
- 基金信息：
  
  the Promotion Project for Health Appropriate Techniques of Chongqing(2020jstg015)
- DOI：10.16016/j.2097-0927.202203113
  CLC： R181.32;R449;R641
- Received：13 March 2022，
  
  Revised：2022-06-01，
  
  Published：15 September 2022
- 稿件说明：
移动端阅览
Ke LI, Yinjie ZHAO, Xiao HOU, et al. Preliminary establishment and evaluation of prognostic warning scoring system for severe trauma[J]. Journal of Army Medical University, 2022, 44(17): 1728-1735.
DOI：

Ke LI, Yinjie ZHAO, Xiao HOU, et al. Preliminary establishment and evaluation of prognostic warning scoring system for severe trauma[J]. Journal of Army Medical University, 2022, 44(17): 1728-1735. DOI： 10.16016/j.2097-0927.202203113.

摘要

目的

探讨严重创伤患者死亡的相关危险因素，初步建立严重创伤预后预警评分系统(以下简称预测模型)，为临床医生早期、及时、准确判断患者预后提供方便。

方法

回顾性分析2019年1月至2021年6月陆军军医大学第一附属医院急救部收治的307例严重创伤患者的临床资料，按预后分为存活组(

=262)和死亡组(

=45)。比较两组患者的年龄、性别、是否有合并基础疾病、受伤机制、损伤部位数、入院时生命体征，血常规、血生化、凝血项、血气分析、入院时是否行气管插管、急诊手术、使用血管活性药物、格拉斯哥昏迷评分(Glasgow coma score

GCS)、创伤严重度评分(injury severity score

ISS)、新创伤严重度评分(new injury

severity score

NISS)等资料，进行单因素分析；将单因素分析中有统计学意义的指标纳入多因素Logistic回归分析，筛选出影响严重创伤患者预后的危险因素，根据回归系数β赋值后建立预测模型；绘制受试者工作特征曲线，评估该预测模型对严重创伤患者预后的预测价值。

结果

两组比较受伤机制、损伤部位数、伤前合并基础疾病、入院时气管插管及使用血管活性药物存在区别，死亡组的年龄、血钠、血肌酐、乳酸、血糖、纤维蛋白降解产物、D-二聚体高于存活组，体温、血钾、活化部分凝血活酶时间、氧合指数、GCS低于存活组；多因素Logistic回归分析结果显示，年龄(≥62.5岁)、血肌酐(≥77.37 mmol/L)、GCS评分(≤12.5分)、氧合指数(≤253.5 mmHg)、体温(≤36.25 ℃)5个指标是严重创伤患者死亡的独立危险因素(

0.05)，5个指标赋分后形成预测模型，将严重创伤患者分为低危、中危和高危组，死亡的发生率分别为2.2%、28.2%、和74.4%。当预测模型的截断值为15.5分时，其敏感度为86.7%，特异度为89.7%，约登指数为0.764。

结论

预测模型由年龄、血肌酐、GCS评分、氧合指数、体温这5个因素组成，其预测效果优于单独应用年龄、血肌酐、GCS评分、氧合指数、体温，较ISS、NISS、急性生理学与慢性健康状况评分系统Ⅱ、序贯器官衰竭评分、改良早期预警风险评分更有优势，更有助于临床上快速准确评估严重创伤患者预后。

Abstract

Objective

To explore the related risk factors of death in patients with severe trauma

and to establish a preliminary early warning scoring system for the prognosis of severe trauma (hereinafter referred to as the prediction model)

so as to provide convenience for clinicians to judge the prognosis of patients early

timely and accurately.

Methods

The clinical data of 307 patients with severe trauma treated in the Emergency Department of the First Affiliated Hospital of Army Medical University from January 2019 to June 2021 were collected and retrospectively analyzed. They were divided into survival group (

=262) and death group (

=45) according to the outcomes. The age

sex

comorbidity

injury mechanism

number of injury sites

vital signs at admission

results of blood routine test

blood biochemistry test and blood coagulation test

blood gas analysis

endotracheal intubation at admission

emergency operation

use of vasoactive drugs and Glasgow coma score (GCS)

injury severity score (ISS)

and new injury severity score (NISS) were compared between the 2 groups with univariate analysis. The statistically significant indexes in univ

ariate analysis were included in multivariate logistic regression analysis

and the risk factors affecting the prognosis of the patients were screened

and the prediction model was established according to the assignment of regression coefficient β

and receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the prediction model for the prognosis of patients with severe trauma.

Results

There were differences in injury mechanism

number of injury sites

comorbidity

endotracheal intubation on admission and use of vasoactive drugs between the 2 groups. The age

serum sodium

serum creatinine (Scr)

lactic acid

blood glucose

fibrin degradation products and D-dimer were higher

while the body temperature

blood potassium

activated partial thrombin time

oxygenation index and GCS were lower in the death group than the survival group. The results of multivariate logistic regression analysis showed that age (≥62.5 years)

Scr (≥77.37 mmol/L)

GCS (≤12.5)

oxygenation index (≤253.5 mmHg) and body temperature (≤36.25 ℃) were independent risk factors for death in the patients with severe trauma (

0.05). The above 5 variables were scored to form the prediction model

which divided severe trauma patients into low-risk

medium-risk and high-risk

and the incidence of death was 2.2%

28.2% and 74.4%

respectively. When the cut-off value of the prediction model was 15.5

the sensitivity was 86.7%

the specificity was 89.4%

and the Yoden index was 0.764.

Conclusion

The prediction model is composed of age

Scr

GCS

oxygenation index and body temperature. Its predictive effect is better than those of the 5 indicators alone

and has more advantages than ISS

NISS

acute physiology and chronic health evaluation Ⅱ

sequential organ failure assessment and modified early warning score. It is more helpful to evaluate the prognosis of patients with severe trauma quickly and accurately.

关键词

Keywords

references

BREUIL V, ROUX C H, CARLE G F. Pelvic fractures: epidemiology, consequences, and medical management[J]. Curr Opin Rheumatol, 2016, 28(4): 442-447. DOI:10.1097/BOR.0000000000000293.

COSTANTINI T W, COIMBRA R, HOLCOMB J B, et al . Current management of hemorrhage from severe pelvic fractures: results of an American Association for the Surgery of Trauma multi-institutional trial[J ] . J Trauma Acute Care Surg, 2016, 80(5): 717-723;discussion723-5. DOI:10.1097/TA.0000000000001034.

姜保国. 我国创伤救治面临的挑战[J]. 中华外科杂志, 2015, 53(6): 401-404. DOI:10.3760/cma.j.issn.0529-5815.2015.06.001.

JIANG B G. The challenges faced in the field of trauma care in China[J]. Chin J Surg, 2015, 53(6): 401-404. DOI:10.3760/cma.j.issn.0529-5815.2015.06.001.[万方]

阿米娜·阿不列孜, 阿合买提江·帕哈丁, 黄扬眉, 等. 生物标志物联合创伤评分对创伤后脓毒症的诊断价值[J]. 创伤外科杂志, 2021, 23(5): 384-390.

AMINA ABULIEZI, AHEMAITIJIANG PAHADING, HUANG YANGMEI, et al . The diagnostic value of biomarkers combined with injury severity score in post-traumatic Sepsis[J ] . J Trauma Surg, 2021, 23(5): 384-390.

DOMINGUES C, NOGUEIRA L, SETTERVALL C H C, et al . Performance of trauma and injury severity score(TRISS) adjustments: an integrati ve review[J ] . Rev Esc Enferm USP, 2015, 49 Spec No: 138-146. DOI:10.1590/S0080-623420150000700020.

LENTSCK M H, OLIVEIRA R R, CORONA L P, et al . Risk factors for death of trauma patients admitted to an Intensive Care Unit[J ] . Rev Lat Am Enfermagem, 2020, 28: e3236. DOI:10.1590/1518-8345.3482.3236.

刘红升, 赵晓东. 严重创伤与急诊重症监护[J]. 中华急诊医学杂志, 2017, 26(7): 731-734. DOI:10.3760/cma.j.issn.1671-0282.2017.07.003.

LIU H S, ZHAO X D. Serious Trauma and Emergency Intensive Care [J]. Chin J Emerg Med, 2017, 26(7): 731-734. DOI:10.3760/cma.j.issn.1671-0282.2017.07.003.

祝各亮, 李琴. 重症监护室内严重创伤患者预后相关因素分析[J]. 中华急诊医学杂志, 2018, 27(2): 194-199. DOI:10.3760/cma.j.issn.1671-0282.2018.02.017.

ZHU G L, LI Q. Prognosis-related factors of severe trauma in intensive care unit[J]. Chin J Emerg Med, 2018, 27(2): 194-199. DOI:10.3760/cma.j.issn.1671-0282.2018.02.017.

吴浩, 赵占江, 梁冰伟. 一体化创伤急救模式在老年严重创伤患者急救中的应用效果[J]. 中国老年学杂志, 2015, 35(10): 2760-2761. DOI:10.3969/j.issn.1005-9202.2015.10.082.

WU H, ZHAO Z J, LIANG B W. Application effect of integrated trauma first aid model in first aid of elderly patients with severe trauma [J]. Chin J Gerontol, 2015, 35(10): 2760-2761. DOI:10.3969/j.issn.1005-9202.2015.10.082.

高扬, 孙天胜. 创伤对老年机体免疫功能的影响[J]. 医学综述, 2013, 19(19): 3500-3503.

GAO Y, SUN T S. The effect of trauma on immune function of the elderly patients[J]. Med Recapitul, 2013, 19(19): 3500-3503.

唐庭轩, 张聪, 李松波, 等. 多发伤并发持续炎症-免疫抑制-分解代谢综合征患者的临床特征及预后分析[J]. 中华急诊医学杂志, 2021, 30(7): 862-865. DOI:10.3760/cma.j.issn.1671-0282.2021.07.012.

TANG T X, ZHANG C, LI S B, et al . A prospective study of clinical characteristics and prognosis in patients with persistent inflammation, immunosuppression and catabolism syndrome after polytrauma[J ] . Chin J Emerg Med, 2021, 30(7): 862-865. DOI:10.3760/cma.j.issn.1671-0282.2021.07.012.

FRÖHLICH M, CASPERS M, LEFERING R, et al . Do elderly trauma patients receive the required treatment? Epidemiology and outcome of geriatric trauma patients treated at different levels of trauma care[J ] . Eur J Trauma Emerg Surg, 2020, 46(6): 1463-1469. DOI:10.1007/s00068-019-01285-0.

KIRSHENBOM D, BEN-ZAKEN Z, ALBILYA N, et al . Older age, comorbid illnesses, and injury severity affect immediate outcome in elderly trauma patients[J ] . J Emerg Trauma Shock, 2017, 10(3): 146- 150. DOI:10.4103/JETS.JETS_62_16.

敬慧丹, 李洪超, 艾山木, 等. 非急诊老年创伤重症患者受伤至手术的间隔时间与预后的关系[J]. 解放军医药杂志, 2019, 31(7): 64-67. DOI:10.3969/j.issn.2095-140X.2019.07.015.

JING H D, LI H C, (AI/YI) S M, et al . Relationship between interval time from trauma to surgery with prognosis in non-emergency elderly patients with severe trauma[J ] . Med Pharm J Chin PLA, 2019, 31(7): 64-67. DOI:10.3969/j.issn.2095-140X.2019.07.015.

王好, 郑凌, 吕桂兰. 连续性血液净化治疗中低体温发生的临床护理进展[J]. 医学研究生学报, 2015, 28(12): 1333-1336. DOI:10.16571/j.cnki.1008-8199.2015.12.022.

WANG H, ZHENG L, LYU G L. Clinical nursing progress of continuous blood purification related hypothermia[J]. J Med Postgrad, 2015, 28(12): 1333-1336. DOI:10.16571/j.cnki.1008-8199.2015.12.022.

FORRISTAL C, VAN AARSEN K, COLUMBUS M, et al . Predictors of hypothermia upon trauma center arrival in severe trauma patients transported to hospital via EMS[J ] . Prehospital Emerg Care, 2020, 24(1): 15-22. DOI:10.1080/10903127.2019.1599474.

RAJASEKHAR A, GOWING R, ZARYCHANSKI R, et al . Survival of trauma patients after massive red blood cell transfusion using a high or low red blood cell to plasma transfusion ratio[J ] . Cri t Care Med, 2011, 39(6): 1507-1513. DOI:10.1097/CCM.0b013e31820eb517.

李楠, 刘思秀, 赵敏, 等. 多发伤后急性肾损伤导致慢性肾功能不全的临床分析[J]. 创伤外科杂志, 2022, 24(3): 214-217. DOI:10.3969/j.issn.1009-4237.2022.03.011.

LI N, LIU S X, ZHAO M, et al . Clinical analysis of chronic kidney disease progression from acute kidney injury caused by multiple injuries[J ] . J Trauma Surg, 2022, 24(3): 214-217. DOI:10.3969/j.issn.1009-4237.2022.03.011.

MD F Z, MD G S, MD G A, et al . Early acute kidney injury based on serum creatinine or cystatin C in intensive care unit after major trauma[J ] . Iran J Med Sci, 2015, 40(6): 485-492.

BARTAL C, ZELLER L, MISKIN I, et al . Crush syndrome: saving more lives in disasters: lessons learned from the early-response phase in Haiti[J ] . Arch Intern Med, 2011, 171(7): 694-696. DOI:10.1001/archinternmed.2011.122.

REITH F C M, VAN DEN BRANDE R, SYNNOT A, et al . The reliability of the Glasgow Coma Scale: a systematic review[J ] . Intens Care Med, 2016, 42(1): 3-15. DOI:10.1007/s00134-015-4124-3.

CEVIK A A, ABU-ZIDAN F M. Searching for mortality predictors in trauma patients: a challenging task[J]. Eur J Trauma Emerg Surg, 2018, 44(4): 561-565. DOI:10.1007/s00068-017-0830-6.

DOLINAY T, KIM Y S, HOWRYLAK J, et al . Inflammasome-regulated cytokines are critical mediators of acute lung injury[J ] . Am J Respir Crit Care Med, 2012, 185(11): 1225-1234. DOI:10.1164/rccm.201201-0003OC.

BERCAULT N, WOLF M, RUNGE I, et al . Intrahospital transport of critically ill ventilated patients: a risk factor for ventilator-associated pneumonia: a matched cohort study[J ] . Crit Care Med, 2005, 33(11): 2471-2478. DOI:10.1097/01.ccm.0000185644.54646.65.

KHILNANI P, DEOPUJARI S, CARCILLO J. Recent advances in Sepsis and septic shock[J]. Indian J Pediatr, 2008, 75(8): 821-830. DOI:10.1007/s12098-008-0154-y.

卢生芳, 郭玉刚, 李长风, 等. 改良早期预警评分和生理评分系统及危险患者评分对急诊科抢救室患者预后评估的应用价值研究[J]. 中国全科医学, 2016, 19(12): 1414-1419. DOI:10.3969/j.issn.1007-9572.2016.12.012.

LU S F, GUO Y G, LI C F, et al . Application value of MEWS, PSS, PARS in the prognosis evaluation of patients in rescue room of emergency department[J ] . Chin Gen Pract, 2016, 19(12): 1414-1419. DOI:10.3969/j.issn.1007-9572.2016.12.012.

余元霞, 陈志明, 李俊丽, 等. PCT联合NEWS预警评分在诊断多发伤后MODS中的应用[J]. 中国现代医生, 2021, 59(25): 102-105, 109.

YU Y X, CHEN Z M, LI J L, et al . Application of procalcitonin combined with National Early Warning Score in the diagnosis of multiple organ dysfunction syndrome after multiple trauma[J ] . China Mod Dr, 2021, 59(25): 102-105, 109.

USUL E, KORKUT S, KAYIPMAZ A E, et al . The role of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) in the pre-hospitalization prediction of Sepsis prognosis[J ] . Am J Emerg Med, 2021, 41: 158-162. DOI:10.1016/j.ajem.2020.09.049.

文军, 乐冬友, 张永军, 等. 改良早期预警评分、改良创伤评分对急诊ICU重症创伤患者临床疗效及预后的评价[J]. 中国医学工程, 2019, 27(5): 52-55. DOI:10.19338/j.issn.1672-2019.2019.05.011.

WEN J, (YUE/LE) D Y, ZHANG Y J, et al . Evaluation of clinical efficacy and prognosis of modified early warning score(MEWS) and revised trauma score(RTS) in emergency ICU patients with severe trauma[J ] . China Med Eng, 2019, 27(5): 52-55. DOI:10.19338/j.issn.1672-2019.2019.05.011.

KADZIOŁKA I, SWISTEK R, BOROWSKA K, et al . Validation of Apache ii and saps ii scales at the intensive care unit along with assessment of sofa scale at the admis sion as an isolated risk of death predictor[J ] . Anaesthesiol Intensi Ther, 2019, 51(2): 107-111. DOI:10.5114/ait.2019.86275.

肖红丽, 孙芳芳, 齐海宇, 等. 早期预警评分及其临床应用进展[J]. 中国危重病急救医学, 2009, 21(11): 697-699. DOI:10.3760/cma.j.issn.10030603.2009.11.024.

XIAO H L, SUN F F, QI H Y, et al . Advances in early warning score and its clinical application[J ] . Chin Crit Care Med, 2009, 21(11): 697-699. DOI:10.3760/cma.j.issn.10030603.2009.11.024.

吉春玲, 周厚荣, 彭春红, 等. GRACE、APACHEⅡ及REMS 3种评分对急性心肌梗死患者近期死亡风险预测价值的比较研究[J]. 中华危重病急救医学, 2013(11): 660-663.

JI C L, ZHOU H R, PENG C H, et al . Comparison of value of GRACE, APACHE Ⅱ and REMS for early prognosis of death in patients with acute myocardial infarction[J ] . Chin Crit Care Med, 2013(11): 660-663.

FERREIRA F L, BOTA D P, BROSS A, et al . Serial evaluation of the SOFA score to predict outcome in critically ill patients[J ] . JAMA, 2001, 286(14): 1754-1758. DOI:10.1001/jama.286.14.1754.

ASAI N, OHASHI W, SAKANASHI D, et al . Combination of Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI) could predict the severity and prognosis of candidemia more accurately than the Acute Physiology, Age, Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score[J ] . BMC Infect Dis, 2021, 21(1): 77. DOI:10.1186/s12879-020-05719-8.

程黎, 马渝, 杨平, 等. 应用SOFA评分评估血液灌流治疗百草枯中毒的临床疗效[J]. 临床急诊杂志, 2013, 14(5): 197-199. DOI:10.13201/j.issn.1009-5918.2013.05.011.

CHENG L, MA Y, YANG P, et al . Evaluation of the therapeutic effect of hemoperfusion in paraquat poisoning by Sepsis-related organ failure assessment score[J ] . J Clin Emerg, 2013, 14(5): 197-199. DOI:10.13201/j.issn.1009-5918.2013.05.011.

OSLER T, BAKER S P, LONG W. A modification of the injury severity score that both improves accuracy and simplifies scoring[J]. J Trauma, 1997, 43(6): 922-925;discussion925-6. DOI:10.1097/00005373-199712000-00009.

HÖKE M H, USUL E, ÖZKAN S. Comparison of trauma severity scores (ISS, NISS, RTS, BIG score, and TRISS) in multiple trauma patients[J]. J Trauma Nurs, 2021, 28(2): 100-106. DOI:10.1097/JTN.0000000000000567.

高劲谋. 多发伤和创伤评分[J]. 中华创伤杂志, 2007, 23(3): 161-163. DOI:10.3760/j:issn:1001-8050.2007.03.001.

GAO J M. Multiple injuries and trauma score[J]. Chin J Traumatol, 2007, 23(3): 161-163. DOI:10.3760/j:issn:1001-8050.2007.03.001.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

A novel estrogen receptor expression stratification (low/moderate/high) based on Chinese population provides more accurate prognosis prediction for HR⁺/HER2^- early breast cancer patients

Immunosuppressive microenvironment of TGIF1-overexpressing gastric cancers and its clinical significance

Impact of molecular heterogeneity of NPM1 mutations on prognosis of acute myeloid leukemia: a clinical report of 86 cases

Association of 5-factor modified frailty index and controlling nutritional status score with overall survival in patients with unresectable hepatocellular carcinoma undergoing interventional therapy

Construction and validation of prediction model for cervical cancer recurrence based on systemic inflammation response index and clinicopathological parameters

Related Author

WANG Chengfang

ZHOU Yuqin

ZHANG Yanling

QI Xiaowei

ZHANG Yi

TONG Huyun

CHEN Xu

ZHANG Wenjie

Related Institution

Department of Breast and Thyroid Surgery， First Affiliated Hospital， Army Medical University （Third Military Medical University）

Department of Gastroenterology， Chongqing Hechuan District People’s Hospital

School of Medicine， Chongqing University

Chongqing Key Laboratory of Precision Prevention and Treatment for Digestive System Tumors， Department of Gastroenterology， Army Medical Center of PLA/Daping Hospital of Third Military Medical University

Department of Hematology, the First Hospital of Lanzhou University

⁰