背景:在严重受伤的患者中,泌尿生殖系统不像许多其他器官系统那样普遍受到影响。尽管延迟和漏诊泌尿生殖系统损伤(GUI)可能会严重损害长期结果,这些伤害经常被忽视。因此,我们提出了一种评分系统,旨在帮助急诊医师诊断严重受伤患者的GUI.
方法:数据来自2015-2021年的TraumaRegisterDGU®。所有严重受伤患者(ISS≥16)≥16岁,在德国接受治疗,奥地利,或瑞士被纳入本研究。我们排除了早期(48小时)转移的患者,以及所有孤立的创伤性脑损伤患者.在对相关预测因素进行单因素分析后,我们使用二元逻辑回归模型开发了一个评分系统。
结果:本研究共纳入70,467例患者,其中4760人(6.8%)维持GUI。男性患者(OR:1.31,95%CI[1.22,1.41])在摩托车事故中受伤(OR:1.70,95%CI[1.55,1.87]),年龄在60岁以下(OR:1.59,95%CI[1.49,1.71])并且在多个身体区域遭受持续伤害(OR:6.63,95%CI[5.88,7.47]),患有严重骨盆带损伤(OR:2.58,95%CI[2.29,2.91])的维持GUI的几率最高。结合这些预测因素,一种新颖的评分系统,GUIPP评分,已开发。它显示出良好的有效性,AUC为0.722(95%CI[0.71;0.73])。
结论:预测严重受伤患者的GUI仍然是治疗医生的挑战,但对于预防受影响患者的不良预后极为重要。GUIPP评分可用于早期启动适当的诊断步骤,以减少GUI的延迟和漏诊。分数≥9分,使GUI非常有可能。
BACKGROUND: The genitourinary system is not as commonly affected as many other organ systems in severely injured patients. Although a delayed and missed diagnosis of genitourinary injuries (GUIs) can severely compromise long-term outcomes, these injuries are frequently overlooked. Therefore, we present a scoring system designed to assist emergency physicians in diagnosing GUIs in severely injured patients.
METHODS: The data were obtained from the TraumaRegister DGU® from the years 2015-2021. All severely injured patients (ISS ≥ 16) ≥16 years of age and treated in Germany, Austria, or Switzerland were included in this study. We excluded patients who were transferred out early (48 h), and all patients with isolated traumatic brain injury. After the univariate analysis of the relevant predictive factors, we developed a scoring system using a binary logistic regression model.
RESULTS: A total of 70,467 patients were included in this study, of which 4760 (6.8%) sustained a GUI. Male patients (OR: 1.31, 95% CI [1.22, 1.41]) injured in motorcycle accidents (OR: 1.70, 95% CI [1.55, 1.87]), who were under 60 years of age (OR: 1.59, 95% CI [1.49, 1.71]) and had sustained injuries in multiple body regions (OR: 6.63, 95% CI [5.88, 7.47]), and suffered severe pelvic girdle injuries (OR: 2.58, 95% CI [2.29, 2.91]) had the highest odds of sustaining a GUI. With these predictive factors combined, a novel scoring system, the GUIPP score, was developed. It showed good validity, with an AUC of 0.722 (95% CI [0.71; 0.73]).
CONCLUSIONS: Predicting GUI in severely injured patients remains a challenge for treating physicians, but is extremely important to prevent poor outcomes for affected patients. The GUIPP score can be utilized to initiate appropriate diagnostic steps early on in order to reduce the delayed and missed diagnosis of GUI, with scores ≥ 9 points making GUIs very likely.