目的:制定用于预测急诊科(ED)急性创伤患者是否需要人工气道手术的评分。
方法:回顾性病例对照。
方法:中国三级综合性医院.
方法:8288名创伤患者在受伤后24小时内入院,并于2012年8月1日至2020年7月31日入院。
方法:研究结果是在入院后24小时内建立了人工气道。根据不同的特征组成,通过多变量逻辑回归在发展队列中得出两个评分.在验证队列中评估预测性能。
结果:O-SPACER(氧饱和度,收缩压,脉搏率,年龄,昏迷比例,眼睛反应,呼吸率)评分基于患者的基本信息,在验证组中曲线下面积(AUC)为0.85(95%CI0.80至0.89)。根据基本信息和创伤评分,IO-SPACER(伤害严重程度评分,氧饱和度,收缩压,脉搏率,年龄,昏迷比例,眼睛反应,制定呼吸率)评分,AUC为0.88(95%CI0.84至0.92)。根据O-SPACER和IO-SPACER评分,患者被分层为低,中高危人群。根据这两个分数,高危患者与人工气道需求增加有关,与低风险患者相比,OR为40.16-40.67。
结论:O-SPACER评分为需要紧急气道介入治疗的受伤患者提供了危险分层,可能有助于指导初始治疗。IO-SPACER评分可以帮助进一步确定患者在创伤后早期是否需要计划的插管或气管切开术。
OBJECTIVE: To develop scores for predicting the need for artificial airway procedures for acute trauma patients in the emergency department (ED).
METHODS: Retrospective case-control.
METHODS: A tertiary comprehensive hospital in China.
METHODS: 8288 trauma patients admitted to the ED within 24 hours of injury and who were admitted from 1 August 2012 to 31 July 2020.
METHODS: The study outcome was the establishment of an artificial airway within 24 hours of admission to the ED. Based on the different feature compositions, two scores were developed in the development cohort by multivariable logistic regression. The predictive performance was assessed in the validation cohort.
RESULTS: The O-SPACER (Oxygen saturation, Systolic blood pressure, Pulse rate, Age, Coma Scale, Eye response, Respiratory rate) score was developed based on the patient\'s basic information with an area under the curve (AUC) of 0.85 (95% CI 0.80 to 0.89) in the validation group. Based on the basic information and trauma scores, the IO-SPACER (Injury Severity Score, Oxygen saturation, Systolic blood pressure, Pulse rate, Age, Coma Scale, Eye response, Respiratory rate) score was developed, with an AUC of 0.88 (95% CI 0.84 to 0.92). According to the O-SPACER and IO-SPACER scores, the patients were stratified into low, medium and high-risk groups. According to these two scores, the high-risk patients were associated with an increased demand for artificial airways, with an OR of 40.16-40.67 compared with the low-risk patients.
CONCLUSIONS: The O-SPACER score provides risk stratification for injured patients requiring urgent airway intervention in the ED and may be useful in guiding initial management. The IO-SPACER score may assist in further determining whether the patient needs planned intubation or tracheotomy early after trauma.