Abstract：
OBJECTIVE: Reduced fibrinogen levels are associated with worse outcomes in bleeding trauma patients. The purpose of this study was to evaluate the potential of the prehospital shock index (SI) and its derivatives, the age shock index (aSI) and the modified shock index (mSI), as predictors of hypofibrinogenaemia in trauma patients.
METHODS: This retrospective study included 2383 patients who presented to a regional trauma center. We reviewed the plasma fibrinogen levels upon admission to the trauma center and patients were divided into two groups: the hypofibrinogenaemia group and the normal group. The predictive performances of the SI, aSI, and mSI were assessed by the area under the receiver operating characteristic curve (AUC).
RESULTS: Of the 2383 patients, 235 (9.9%) had hypofibrinogenaemia. Patients with hypofibrinogenaemia were more likely to receive transfusions within 4 h and had significantly greater in-hospital mortality than patients with normal fibrinogen levels. The AUCs of prehospital SI, prehospital aSI, and prehospital mSI for the prediction of hypofibrinogenaemia were 0.75 (95% confidence interval [CI] 0.73-0.77), 0.70 (95% CI 0.68-0.72), and 0.75 (95% CI 0.73-0.77), respectively.
CONCLUSIONS: Prehospital SI and prehospital mSI demonstrated moderate performance for identifying trauma patients with hypofibrinogenaemia. The prehospital aSI had poor predictive performance. In the prehospital setting, the use of prehospital SI or prehospital mSI as the sole predictor of hypofibrinogenaemia in trauma patients is not recommended.
METHODS: This retrospective study included 2383 patients who presented to a regional trauma center. We reviewed the plasma fibrinogen levels upon admission to the trauma center and patients were divided into two groups: the hypofibrinogenaemia group and the normal group. The predictive performances of the SI, aSI, and mSI were assessed by the area under the receiver operating characteristic curve (AUC).
RESULTS: Of the 2383 patients, 235 (9.9%) had hypofibrinogenaemia. Patients with hypofibrinogenaemia were more likely to receive transfusions within 4 h and had significantly greater in-hospital mortality than patients with normal fibrinogen levels. The AUCs of prehospital SI, prehospital aSI, and prehospital mSI for the prediction of hypofibrinogenaemia were 0.75 (95% confidence interval [CI] 0.73-0.77), 0.70 (95% CI 0.68-0.72), and 0.75 (95% CI 0.73-0.77), respectively.
CONCLUSIONS: Prehospital SI and prehospital mSI demonstrated moderate performance for identifying trauma patients with hypofibrinogenaemia. The prehospital aSI had poor predictive performance. In the prehospital setting, the use of prehospital SI or prehospital mSI as the sole predictor of hypofibrinogenaemia in trauma patients is not recommended.
摘要：
目的：纤维蛋白原水平降低与创伤出血患者预后较差相关。这项研究的目的是评估院前休克指数（SI）及其衍生物的潜力，年龄冲击指数(aSI)和修正冲击指数(mSI)，作为创伤患者低纤维蛋白原血症的预测因子。
方法：这项回顾性研究纳入了2383例患者，这些患者就诊于某地区创伤中心。我们回顾了进入创伤中心后的血浆纤维蛋白原水平，将患者分为两组：低纤维蛋白原血症组和正常组。SI的预测性能，aSI,通过受试者工作特征曲线下面积（AUC）评估mSI。
结果：在2383名患者中，235（9.9％）患有低纤维蛋白原血症。与纤维蛋白原水平正常的患者相比，低纤维蛋白原血症患者在4小时内更有可能接受输血，并且住院死亡率明显更高。院前SI的AUC，院前ASI，预测低纤维蛋白原血症的院前mSI为0.75（95％置信区间[CI]0.73-0.77），0.70（95%CI0.68-0.72），和0.75（95%CI0.73-0.77），分别。
结论：院前SI和院前mSI在识别低纤维蛋白原血症的创伤患者方面表现中等。院前aSI的预测性能较差。在院前环境中，不建议在创伤患者中使用院前SI或院前mSI作为低纤维蛋白原血症的唯一预测因子.
方法：这项回顾性研究纳入了2383例患者，这些患者就诊于某地区创伤中心。我们回顾了进入创伤中心后的血浆纤维蛋白原水平，将患者分为两组：低纤维蛋白原血症组和正常组。SI的预测性能，aSI,通过受试者工作特征曲线下面积（AUC）评估mSI。
结果：在2383名患者中，235（9.9％）患有低纤维蛋白原血症。与纤维蛋白原水平正常的患者相比，低纤维蛋白原血症患者在4小时内更有可能接受输血，并且住院死亡率明显更高。院前SI的AUC，院前ASI，预测低纤维蛋白原血症的院前mSI为0.75（95％置信区间[CI]0.73-0.77），0.70（95%CI0.68-0.72），和0.75（95%CI0.73-0.77），分别。
结论：院前SI和院前mSI在识别低纤维蛋白原血症的创伤患者方面表现中等。院前aSI的预测性能较差。在院前环境中，不建议在创伤患者中使用院前SI或院前mSI作为低纤维蛋白原血症的唯一预测因子.
