Predictive Value of Prehospital Point-of-Care Glucose Measurement and Shock Indices in Traumatically Injured Patients: A Retrospective Study

Q3 Nursing
Joseph Hill MSN, APRN, FNP-C, CFRN, CMTE , Jeremy Norman MBA, NRP, FP-C , M. David Gothard MS , Michelle M. McLean MD , Deanne Krajkowski BS CTRS , Bethany Figg Ded.T, MBA, MLIS, C-TAGME, AHIP , Jeff Marr FP-C
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引用次数: 0

Abstract

Objective

Stress-induced hyperglycemia is a well-established risk factor for mortality in critically ill trauma patients. Limited research exists on prehospital diagnostic tools for predicting hemorrhagic shock and mortality in this population.

Methods

A retrospective study involving 435 adult and pediatric trauma patients transported by air ambulance in 13 years aimed to assess the predictive value of prehospital point-of-care glucose (POCG), shock index (SI), Glasgow Coma Scale (GCS), fluid administration, and reverse SI multiplied by GCS (rSIG) for 24-hour and 30-day mortalities.

Results

Univariate analyses revealed that an elevated SI and lower GCS were associated with increased mortality, whereas POCG and crystalloid fluid administration were not significant predictors. Multivariate analysis confirmed SI and GCS as independent predictors of 30-day mortality. The rSIG emerged as the strongest predictor, with an Area Under the Receiver Operating Characteristic curve (AUROC) of 0.872. POCG alone did not demonstrate statistical significance in predicting mortality.

Conclusion

Prehospital SI and GCS are valuable predictors of mortality, with rSIG offering the highest predictive accuracy. Despite limitations, this study suggests the potential impact of prehospital markers on trauma-related outcomes, emphasizing the need for further research validation.
院前即时血糖测量和休克指标对创伤性损伤患者的预测价值:一项回顾性研究
目的应激性高血糖是创伤危重症患者死亡的危险因素。有限的研究存在院前诊断工具预测失血性休克和死亡率在这一人群。方法一项回顾性研究纳入了13年来由空中救护车运送的435名成人和儿童创伤患者,旨在评估院前护理点血糖(POCG)、休克指数(SI)、格拉斯哥昏迷量表(GCS)、液体给药以及反向SI乘以GCS (rSIG)对24小时和30天死亡率的预测价值。结果单因素分析显示,SI升高和GCS降低与死亡率增加相关,而POCG和晶体液体给药不是显著的预测因子。多变量分析证实SI和GCS是30天死亡率的独立预测因子。rSIG是最强的预测因子,其受试者工作特征曲线下面积(AUROC)为0.872。单独的POCG在预测死亡率方面没有统计学意义。结论院前SI和GCS是有价值的死亡率预测指标,其中rSIG预测准确率最高。尽管存在局限性,但本研究提示院前标志物对创伤相关结果的潜在影响,强调需要进一步的研究验证。
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来源期刊
Air Medical Journal
Air Medical Journal Nursing-Emergency Nursing
CiteScore
1.20
自引率
0.00%
发文量
112
审稿时长
69 days
期刊介绍: Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.
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