背景:在急诊科(ED)确保对创伤性脑损伤(TBI)患者的快速和精确的死亡率预测对于患者分诊和提高预后至关重要。我们的目的是估计和比较年龄创伤评级指数的预测能力,格拉斯哥昏迷量表,呼吸频率,收缩压评分(TRIAGES)和修订后的创伤评分(RTS)对孤立性TBI患者24小时住院死亡率的影响。
方法:我们进行了一项回顾性单中心研究,分析了2020年1月1日至2020年12月31日在南通大学附属医院急诊室接受治疗的1156例孤立性急性TBI患者的临床资料。我们计算了每个患者的TRIAGES和RTS评分,并使用受试者工作特征(ROC)曲线估计了其短期死亡率的预测值。
结果:87例患者(7.53%)在入院24小时内死亡。非存活组比存活组有更高的TRIAGES和更低的RTS。与非幸存者相比,幸存者的格拉斯哥昏迷量表评分(GCS)较高,中位评分为15分(12,15分),中位评分为4.0分(3.0,6.0分).TRIAGES的粗比值比和调整后比值比(ORs)分别为1.79,95%CI(1.62至1.98)和1.79,95%CI(1.60至2.00),分别。RTS的粗OR和调整OR分别为0.39,95%CI(0.33至0.45)和0.40,95%CI(0.34至0.47),分别。TRIAGES的ROC(AUROC)曲线下面积,RTS,GCS为0.865(0.844至0.884),0.863(0.842至0.882),和0.869(0.830至0.909),分别。对于TRIAGES,预测24小时住院死亡率的最佳临界值为3,对于RTS6.08,8为GCS。亚组分析显示,在65岁及以上的患者中,TRIAGES(0.845)的AUROC高于GCS(0.836)和RTS(0.829),尽管差异无统计学意义。
结论:TRIAGES和RTS在预测孤立性TBI患者的24小时住院死亡率方面显示出良好的疗效,具有与GCS相当的性能。然而,提高评估的全面性并不一定转化为预测能力的整体提高。
Ensuring rapid and precise mortality prediction in patients with traumatic brain injury (TBI) at the emergency department (ED) is paramount in patient triage and enhancing their outcomes. We aimed to estimate and compare the predictive power of the Trauma Rating Index in Age, Glasgow Coma Scale, Respiratory rate, and Systolic blood pressure score (TRIAGES) and Revised Trauma Score (
RTS) for 24-h in-hospital mortality in patients with isolated TBI.
We conducted a retrospective single-center study analyzing clinical data from 1156 patients with isolated acute TBI treated in the ED of the Affiliated Hospital of Nantong University from January 1, 2020, to December 31, 2020. We calculated each patient\'s TRIAGES and
RTS scores and estimated their predictive value for short-term mortality using receiver operating characteristic (ROC) curves.
87 patients (7.53%) died within 24 h of admission. The non-survival group had higher TRIAGES and lower
RTS than the survival group. Compared to non-survivors, survivors exhibited higher Glasgow Coma Scale scores (GCS) with a median score of 15 (12, 15) compared to a median score of 4.0 (3.0, 6.0). The crude and adjusted odds ratios (ORs) for TRIAGES were 1.79, 95% CI (1.62 to 1.98) and 1.79, 95% CI (1.60 to 2.00), respectively. The crude and adjusted ORs for
RTS were 0.39, 95% CI (0.33 to 0.45) and 0.40, 95% CI (0.34 to 0.47), respectively. The area under the ROC (AUROC) curve of TRIAGES, RTS, and GCS was 0.865 (0.844 to 0.884), 0.863 (0.842 to 0.882), and 0.869 (0.830 to 0.909), respectively. The optimal cut-off values for predicting 24-h in-hospital mortality were 3 for TRIAGES, 6.08 for
RTS, and 8 for GCS. The subgroup analysis showed a higher AUROC in TRIAGES (0.845) compared to GCS (0.836) and RTS (0.829) among patients aged 65 and above, although the difference was not statistically significant.
TRIAGES and RTS have shown promising efficacy in predicting 24-h in-hospital mortality in patients with isolated TBI, with comparable performance to GCS. However, improving the comprehensiveness of assessment does not necessarily translate into an overall increase in predictive ability.