接受独立最终手术的多发创伤患者不良事件的时间相关预测因素

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-04-16 DOI:10.1016/j.jcot.2025.103017

Philipp Vetter, Cédric Niggli, Jan Hambrecht, Hans-Christoph Pape, Ladislav Mica

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引用次数: 0

摘要

背景及时分诊对多发外伤患者至关重要。那些损伤严重程度和生理应激较低的患者通常接受孤立的明确手术，但该组不良事件（ae）的预测因素尚不清楚。本研究旨在确定多创伤患者接受独立最终手术（不包括损伤控制干预）时ae的时间相关预测因素。方法分析1996年至2022年的创伤数据库，包括3653例患者。研究重点是年龄≥16岁、损伤严重程度评分(ISS)≥16且接受明确骨科手术的个体。入院时、入院后第1天和第2天记录损伤和生理参数。记录在案的不良事件包括全身性炎症反应综合征（SIRS）、败血症和死亡率。结果276例患者(平均年龄45.0岁，可信区间CI 42.7 ~ 47.2岁；男性占71.7%；中位ISS: 27，四分位数范围：20-34)，SIRS发生率为79% (n = 218)，败血症发生率为13.8% (n = 38)，死亡率为4% （n = 11）。入院时，严重的头部和面部损伤和白细胞计数（LC）升高预示着SIRS。脓毒症的预测因子包括ISS、心率、pH值和凝血酶原时间（PT），而非幸存者年龄较大，头部损伤更严重，碱性过剩（BE）更低。第一天，脓毒症患者和非幸存者的乳酸水平均升高；LC预测败血症。到第2天，两组患者的乳酸水平持续升高，非幸存者也表现出BE和PT的降低。初次手术（入院当天）和多次手术与SIRS相关，而延迟手术与败血症相关。手术因素与死亡率无相关性。结论创伤严重程度、生理及手术因素与终期手术多发ae相关。这些重新评估的结果可能有助于指导决策，以尽量减少不良反应的风险。证据水平：短期研究，证据水平= III。registrationNo审判。StV: 1 - 2008。

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Time-related predictors for adverse events in polytrauma patients undergoing stand-alone definitive surgery

Background

Timely triage is crucial for polytrauma patients. Those with lower injury severity and physiological stress typically undergo isolated definitive surgery, but predictors for adverse events (AEs) in this group remain unclear. This study aims to identify time-related predictors of AEs in polytrauma patients undergoing stand-alone definitive surgery, excluding damage control interventions.

Methods

We analyzed a trauma database spanning from 1996 to 2022, including 3653 patients. The focus was on individuals aged ≥16 years with an Injury Severity Score (ISS) ≥16 who underwent definitive orthopedic surgery. Injury and physiological parameters were recorded at admission and on the first and second days post-admission. Documented AEs included systemic inflammatory response syndrome (SIRS), sepsis, and mortality.

Results

Among the 276 patients (mean age: 45.0 years with confidence interval, CI, 42.7–47.2 years; 71.7 % male; median ISS: 27 with interquartile range: 20–34), the incidence of SIRS was 79 % (n = 218), sepsis 13.8 % (n = 38), and mortality 4 % (n = 11). Upon admission, severe head and facial injuries and elevated leucocyte count (LC) predicted SIRS. Predictors for sepsis included ISS, heart rate, pH, and prothrombin time (PT), while non-survivors were older, with more severe head injuries and lower base excess (BE). On day one, elevated lactate levels were noted in both septic patients and non-survivors; LC predicted sepsis. By day two, higher lactate persisted in both groups, with non-survivors also showing reduced BE and PT. Primary (admission day) and multiple surgeries correlated with SIRS, whereas delayed surgeries were associated with sepsis. No surgical factors were correlated with mortality.

Conclusion

Injury severity, physiological and surgical factors are associated with AEs in polytrauma patients undergoing definitive surgery. These findings with re-evaluation may help guide decision-making to minimize the risk of AEs.

Level of evidence

Cohort-study, Level of Evidence = III.

Trial registration

No. StV: 1-2008.

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.