背景:生命体征是评估损伤严重程度和指导创伤复苏的重要因素,尤其是严重受伤的病人。尽管如此,创伤登记处经常缺少生理数据。这项研究旨在评估基于医院的创伤注册表中缺少院前数据的程度,并评估院前生理数据完整性与损伤严重程度指标之间的关联。
方法:对直接送往多伦多一级创伤中心的所有成年创伤患者进行了回顾性研究,安大略省由护理人员从2015年1月1日至2019年12月31日。评估每个变量的缺失数据比例,并评估缺失模式。调查院前数据完整性与损伤严重程度因素之间的关系,我们进行了描述性和未校正的逻辑回归分析.
结果:共纳入3,528例患者。我们认为院前数据缺失,如果有心率,收缩压,呼吸频率或氧饱和度不完全。在大约20%的患者中,每个个体变量在注册表中缺失,氧饱和度缺失最常见(n=831;23.6%)。超过25%(n=909)的患者至少缺少一个院前生命体征,其中69.1%(n=628)缺少所有这四个变量。数据不完整的患者受伤更严重,死亡率较高,更频繁地接受救生干预措施,如输血和插管。如果患者在创伤湾死亡,则最有可能丢失院前生理数据(未调整OR:9.79;95%CI:6.35-15.10),无法存活至出院(未调整OR:3.55;95%CI:2.76-4.55),或院前GCS小于9(OR:3.24;95%CI:2.59-4.06)。
结论:在这个单中心创伤登记中,关键的院前变量经常缺失,尤其是受重伤的患者。数据缺失的患者死亡率较高,更严重的伤害特征,并在创伤湾接受了更多的救命干预措施,提示院前生命体征缺失存在损伤严重程度偏差。为了确保基于创伤登记数据的研究的有效性,必须仔细考虑错误的模式,以确保适当解决丢失的数据。
BACKGROUND: Vital signs are important factors in assessing injury severity and guiding trauma resuscitation, especially among severely injured patients. Despite this, physiological data are frequently missing from trauma registries. This study aimed to evaluate the extent of missing prehospital data in a hospital-based trauma registry and to assess the associations between prehospital physiological data completeness and indicators of injury severity.
METHODS: A retrospective review was conducted on all adult trauma patients brought directly to a level 1 trauma center in Toronto, Ontario by paramedics from January 1, 2015, to December 31, 2019. The proportion of missing data was evaluated for each variable and patterns of missingness were assessed. To investigate the associations between prehospital data completeness and injury severity factors, descriptive and unadjusted logistic regression analyses were performed.
RESULTS: A total of 3,528 patients were included. We considered prehospital data missing if any of heart rate, systolic blood pressure, respiratory rate or oxygen saturation were incomplete. Each individual variable was missing from the registry in approximately 20 % of patients, with oxygen saturation missing most frequently (n = 831; 23.6 %). Over 25 % (n = 909) of patients were missing at least one prehospital vital sign, of which 69.1 % (n = 628) were missing all four of these variables. Patients with incomplete data were more severely injured, had higher mortality, and more frequently received lifesaving interventions such as blood transfusion and intubation. Patients were most likely to have missing prehospital physiological data if they died in the trauma bay (unadjusted OR: 9.79; 95 % CI: 6.35-15.10), did not survive to discharge (unadjusted OR: 3.55; 95 % CI: 2.76-4.55), or had a prehospital GCS less than 9 (OR: 3.24; 95 % CI: 2.59-4.06).
CONCLUSIONS: In this single center trauma registry, key prehospital variables were frequently missing, particularly among more severely injured patients. Patients with missing data had higher mortality, more severe injury characteristics and received more life-saving interventions in the trauma bay, suggesting an injury severity bias in prehospital vital sign missingness. To ensure the validity of research based on trauma registry data, patterns of missingness must be carefully considered to ensure missing data is appropriately addressed.