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首页> 外文期刊>International Journal of Environmental Research and Public Health >Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach
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Polytrauma Defined by the New Berlin Definition: A Validation Test Based on Propensity-Score Matching Approach

机译：新柏林定义所定义的多发伤：基于倾向得分匹配方法的验证测试

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Background: Polytrauma patients are expected to have a higher risk of mortality than that obtained by the summation of expected mortality owing to their individual injuries. This study was designed to investigate the outcome of patients with polytrauma, which was defined using the new Berlin definition, as cases with an Abbreviated Injury Scale (AIS) ≥ 3 for two or more different body regions and one or more additional variables from five physiologic parameters (hypotension [systolic blood pressure ≤ 90 mmHg], unconsciousness [Glasgow Coma Scale score ≤ 8], acidosis [base excess ≤ ?6.0], coagulopathy [partial thromboplastin time ≥ 40 s or international normalized ratio ≥ 1.4], and age [≥70 years]). Methods: We retrieved detailed data on 369 polytrauma patients and 1260 non-polytrauma patients with an overall Injury Severity Score (ISS) ≥ 18 who were hospitalized between 1 January 2009 and 31 December 2015 for the treatment of all traumatic injuries, from the Trauma Registry System at a level I trauma center. Patients with burn injury or incomplete registered data were excluded. Categorical data were compared with two-sided Fisher exact or Pearson chi-square tests. The unpaired Student t -test and the Mann–Whitney U -test was used to analyze normally distributed continuous data and non-normally distributed data, respectively. Propensity-score matched cohort in a 1:1 ratio was allocated using the NCSS software with logistic regression to evaluate the effect of polytrauma on patient outcomes. Results: The polytrauma patients had a significantly higher ISS than non-polytrauma patients (median (interquartile range Q1–Q3), 29 (22–36) vs. 24 (20–25), respectively; p < 0.001). Polytrauma patients had a 1.9-fold higher odds of mortality than non-polytrauma patients (95% CI 1.38–2.49; p < 0.001). Compared to non-polytrauma patients, polytrauma patients had a substantially longer hospital length of stay (LOS). In addition, a higher proportion of polytrauma patients were admitted to the intensive care unit (ICU), spent longer LOS in the ICU, and had significantly higher total medical expenses. Among 201 selected propensity score-matched pairs of polytrauma and non-polytrauma patients who showed no significant difference in sex, age, co-morbidity, AIS ≥ 3, and Injury Severity Score (ISS), the polytrauma patients had a significantly higher mortality rate (OR 17.5, 95% CI 4.21–72.76; p < 0.001), and a higher proportion of patients admitted to the ICU (84.1% vs. 74.1%, respectively; p = 0.013) with longer stays in the ICU (10.3 days vs. 7.5 days, respectively; p = 0.003). The total medical expenses for polytrauma patients were 35.1% higher than those of non-polytrauma patients. However, there was no significant difference in the LOS between polytrauma and non-polytrauma patients (21.1 days vs. 19.8 days, respectively; p = 0.399). Conclusions: The findings of this propensity-score matching study suggest that the new Berlin definition of polytrauma is feasible and applicable for trauma patients.
机译：背景：多发伤患者的预期死亡风险要高于因个人受伤而导致的预期死亡率总和。本研究旨在调查采用新的柏林定义定义的多发伤患者的预后，即两个或两个以上不同身体区域的缩写伤害量表（AIS）≥3以及五个生理指标中一个或多个其他变量的病例参数（低血压[收缩压≤90 mmHg]，意识不清[格拉斯哥昏迷评分≤8，酸中毒[基础过量≤？6.0]，凝血障碍[部分凝血活酶时间≥40 s或国际标准化比率≥1.4]和年龄[ ≥70岁]。方法：我们从创伤登记处检索了在2009年1月1日至2015年12月之间住院治疗所有创伤的369例多发伤患者和1260例总损伤严重度得分（ISS）≥18的非多发伤患者的详细数据。系统位于一级创伤中心。烧伤或注册数据不完整的患者被排除在外。将分类数据与双面Fisher精确或Pearson卡方检验进行比较。未配对的Student t检验和Mann-Whitney U检验分别用于分析正态分布的连续数据和非正态分布的数据。使用NCSS软件和logistic回归分配以1：1比例进行倾向得分匹配的队列，以评估多发伤对患者预后的影响。结果：多发伤患者的ISS显着高于非多发伤患者（中位（四分位间距Q1-Q3），分别为29（22-36）对24（20-25）; p <0.001）。多发伤患者的死亡率是非多发伤患者的1.9倍（95％CI 1.38–2.49; p <0.001）。与非多发伤患者相比，多发伤患者的住院时间（LOS）明显更长。此外，重症监护病房（ICU）收治的多发伤患者比例更高，在ICU中花费更长的LOS，并且总医疗费用明显更高。在201份性别，年龄，合并症，AIS≥3和伤害严重度评分（ISS）均无显着差异的多创伤和非多创伤患者的倾向评分匹配对中，多创伤患者的死亡率显着较高（OR 17.5，95％CI 4.21–72.76; p <0.001），入住ICU的患者比例较高（分别为84.1％和74.1％; p = 0.013），而在ICU停留的时间更长（10.3天vs分别为7.5天; p = 0.003）。多发伤患者的总医疗费用比非多发伤患者的高35.1％。然而，多发伤患者和非多发伤患者之间的LOS没有显着差异（分别为21.1天和19.8天; p = 0.399）。结论：该倾向得分匹配研究的结果表明，柏林多创伤的新定义是可行的，适用于创伤患者。

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