AIS > 2 in at least two body regions: A potential new anatomical definition of polytrauma
AIS > 2 in at least two body regions: A potential new anatomical definition of polytrauma
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DOI：
10.1016/j.injury.2011.06.029
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发表时间：
2012-02-01
影响因子：
2.5
通讯作者：
Balogh, Zsolt J.
中科院分区：
文献类型：
--
作者：
Butcher, Nerida;Balogh, Zsolt J.
背景：术语“多发性创伤”缺乏一个普遍接受的，有效的定义。在临床试验中，通常应用的基于损伤严重度的解剖学评分截止值为ISS > 15，ISS > 17，并且最近推荐的AIS在至少两个身体区域中> 2（2 x AIS > 2）。目的：比较临床定义的多发伤患者与基于解剖评分定义的多发伤患者的结局。材料和方法：本研究纳入了一项前瞻性观察性研究，研究对象是在1级创伤中心就诊的所有创伤团队激活患者，为期7个月。前瞻性数据收集包括每个身体区域的AIS、ISS、ICU住院时间（LOS）、多器官衰竭（MOF）和死亡率。结果：336例患者符合入选标准（年龄：41 ± 20岁，74%为男性，ISS：15 ± 11岁，NISS：19 ± 15岁，MOF：3%，死亡率：4%，25%入住ICU）。ISS > 15：13例死亡（10%），71例（54%）需要入住ICU，10例（8%）发生MOF。ISS > 17捕获了11例死亡（11%），其中63例（62%）需要ICU入院，10例（10%）发生MOF。定义为（2 x AIS > 2）：8例死亡（占该组的13%），43例患者需要入住ICU（67%），9例（14%）发生MOF。当检查这三种方法的性能时，ISS > 15和ISS > 17在统计学上捕获了相同数量的临床定义的多发伤患者（p = 0.4106），而2 x AIS > 2定义比ISS > 15定义捕获了更多的多发性创伤患者结论：2 x AIS > 2捕获了最大百分比的最差结果，并且显著更大百分比的临床定义的多发伤患者。2 x AIS > 2在定义多发伤方面的准确性和精确度高于ISS > 15和ISS > 17。这种简单的、回顾性的、可重复的标准保证了更大规模的验证。(C)2011爱思唯尔有限公司版权所有。
Background: The term 'polytrauma' lacks a universally accepted, validated definition. In clinical trials the commonly applied injury severity based anatomical score cut-offs are ISS > 15, ISS > 17 and a recently recommended AIS > 2 in at least two body regions (2 x AIS > 2).Purpose: To compare the outcomes of clinically defined polytrauma patients with those defined based on anatomical scores.Material and methods: A prospective observational study on all trauma team activation patients over a 7-month period presenting at a level-1 trauma centre were included in the study. The prospective data collection included AIS in each body region, ISS, ICU length of stay (LOS), multiple organ failure (MOF) and mortality.Results: 336 patients met inclusion criteria (age: 41 +/- 20, 74% male, ISS: 15 +/- 11, NISS: 19 +/- 15, MOF: 3%, mortality: 4%, 25% ICU admission). ISS > 15: 13 deaths (10%), 71 (54%) required ICU admission and 10 (8%) developed MOF. ISS > 17 captured 11 deaths (11%), with 63 (62%) requiring ICU admission and 10 (10%) developing MOF. Defining as (2 x AIS > 2): 8 deaths (13% of the group), with 43 patients requiring ICU admission (67%) and 9 (14%) developing MOF. When examining the performance of these three approaches, the ISS > 15 and the ISS > 17 captured statistically the same amount of clinically defined polytrauma patients (p = 0.4106), while the 2 x AIS > 2 definition captured significantly more polytrauma patients than ISS > 15 (p = 0.0251) and ISS > 17 (p = 0.0019).Conclusion: 2 x AIS > 2 captured the greatest percentage of the worst outcomes and significantly larger % of the clinically defined polytrauma patients. 2 x AIS > 2 has higher accuracy and precision in defining polytrauma than ISS > 15 and ISS > 17. This simple, retrospectively also reproducible criteria warrants larger scale validation. (C) 2011 Elsevier Ltd. All rights reserved.