Video Experimental Relacionado

Updated: Sep 9, 2025

Operant Protocols for Assessing the Cost-benefit Analysis During Reinforced Decision Making by Rodents

Operant Protocols for Assessing the Cost-benefit Analysis During Reinforced Decision Making by Rodents

Published on: September 10, 2018

Validación externa de los criterios revisados de la tríada letal para la toma de decisiones estratégicas adecuadas

Keisuke Suzuki¹, Akira Endo, Tomohiro Akutsu

¹From the Department of Acute Critical Care Medicine (K.S., A.E., T.A., H.H.), Tsuchiura Kyodo General Hospital, Tsuchiura; Trauma and Acute Critical Care Medical Center (K.S., A.E., T.A., H.H., A.S., W.T., K. Morishita), Institute of Science Tokyo, Bunkyo-ku; Advanced Medical Emergency Department and Critical Care Center (T.O.), Saiseikai Utsunomiya Hospital, Utsunomiya; Emergency and Trauma Center (A.S.), Kameda Medical Center, Kamogawa; Division of Emergency and Critical Care Medicine (S.K., M.F.), Tohoku University, Sendai; Department of Surgery (Tasuku M.), Kenwakai Otemachi Hospital, Kitakyushu; Department of Trauma and Emergency Surgery (N.H.), Saiseikai Yokohamashi Tobu Hospital, Yokohama; Department of Critical Care Medicine and Trauma (K.I), National Hospital Organization Disaster Medical Center, Tachikawa; Department of Emergency and Critical Care Medicine (T.H.), St. Luke's International Hospital, Chuo-ku; Advanced Critical Care Center (Takahito M.), Gifu University Hospital, Gifu; Department of Emergency and Critical Care Medicine (A.M.), Saga University Hospital, Saga; Department of Emergency, Critical Care, and Disaster Medicine (H.N.), Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama; Trauma and Critical Care Center (T.S.), Japanese Red Cross Kumamoto Hospital, Kumamoto; Department of Emergency and Critical Care Medicine (K. Miyazaki), Nara Medical University Hospital, Kashihara; Department of Critical Care and Emergency Medicine (N.U.), Japanese Red Cross Maebashi Hospital, Maebashi; Department of Traumatology and Critical Care Medicine (Y.S.), Osaka Metropolitan University Hospital, Osaka; Emergency Medical Center (K. Kirizume), Kagawa Medical University, Kita-gun; Department of Emergency Medicine (A.I.), Japan Red Cross Okayama Hospital, Okayama; Department of Emergency and Critical Care Medicine (Y.Y.), Hachinohe City Hospital, Hachinohe; Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine (T.W.), Faculty of Medicine, Hokkaido University, Sapporo; Emergency Department (K. Kato), Obihiro Kosei Hospital, Obihiro; Department of Emergency and Critical Care Medicine (K.S.), Juntendo University Urayasu Hospital, Urayasu; Emergency and Critical Care Medicine (M.H.), Kindai University Faculty of Medicine, Osakasayama; and Emergency and Critical Care Center (T.K.), Mie University Hospital, Tsu, Japan.

The journal of trauma and acute care surgery

|September 4, 2025

Resumen

Los criterios de la tríada letal revisados mejoran la predicción de la mortalidad a los 28 días en pacientes con trauma severo. Estos criterios actualizados ofrecen una mayor sensibilidad y especificidad que los métodos convencionales para guiar estrategias terapéuticas críticas.

Área de la Ciencia:

Cuidados intensivos para traumatismos
Modelado de pronósticos
Apoyo a la decisión clínica

Sus antecedentes:

Los criterios convencionales de la tríada letal para el trauma son demasiado específicos, limitando su uso en la toma de decisiones estratégicas.
Anteriormente se propusieron criterios de tríada letal revisados basados en datos de estudios multicéntricos.
Criterios revisados positivos: uno mayor (FDP > 90 μg/mL) o dos menores (exceso de base <-3 mEq/L o temperatura <36°C).

Objetivo del estudio:

Para validar externamente los criterios revisados de la tríada letal.
Evaluar el rendimiento predictivo de los criterios revisados para la mortalidad a los 28 días en pacientes gravemente lesionados.

Principales métodos:

Análisis de 1.177 pacientes gravemente heridos (puntuación de gravedad de la lesión ≥16) de 25 instituciones japonesas (abril de 2018-marzo de 2019).
Evaluación de la proporción de pacientes elegibles para el cálculo de los criterios revisados.
Evaluación de la precisión predictiva utilizando las curvas características de funcionamiento del receptor y los gráficos de calibración.

Principales resultados:

Los criterios revisados fueron calculables para el 65,4% de los pacientes.
Los criterios revisados demostraron una sensibilidad del 80,6% y una especificidad del 64,4% para la mortalidad a los 28 días.
El área bajo la curva ROC para los criterios revisados (0,77) fue superior a los criterios convencionales (0,68).
Los gráficos de calibración indicaron una alta concordancia entre la mortalidad prevista y la observada.

Conclusiones:

Los criterios de la tríada letal revisados muestran una sensibilidad clínicamente suficiente y una especificidad adecuada para predecir la mortalidad a los 28 días en traumas graves.
Estos criterios son indicadores valiosos para la implementación de estrategias terapéuticas críticas en el cuidado del trauma.
La validación externa apoya la utilidad de los criterios de la tríada letal revisados en el manejo de pacientes con trauma.

Palabras clave:

El trauma control de los daños La tríada letal la validación

Más Videos Relacionados

Revised and Neuroimaging-Compatible Versions of the Dual Task Screen

Revised and Neuroimaging-Compatible Versions of the Dual Task Screen

Published on: October 5, 2020

Multimodal Protocol for Assessing Metacognition and Self-Regulation in Adults with Learning Difficulties

Multimodal Protocol for Assessing Metacognition and Self-Regulation in Adults with Learning Difficulties

Published on: September 27, 2020

Videos de Conceptos Relacionados

Decision Making: Traditional Method

Decision Making: Traditional Method

The process of hypothesis testing based on the traditional method includes calculating the critical value, testing the value of the test statistic using the sample data, and interpreting these values.
First, a specific claim about the population parameter is decided based on the research question and is stated in a simple form. Further, an opposing statement to this claim is also stated. These statements can act as null and alternative hypotheses, out of which a null hypothesis would be a...

Decision Making: P-value Method

Decision Making: P-value Method

The process of hypothesis testing based on the P-value method includes calculating the P- value using the sample data and interpreting it.
First, a specific claim about the population parameter is proposed. The claim is based on the research question and is stated in a simple form. Further, an opposing statement to the claim is also stated. These statements can act as null and alternative hypotheses: a null hypothesis would be a neutral statement while the alternative hypothesis can...

Decision Making

Decision Making

Decision-making is a fundamental cognitive process that involves evaluating alternatives and selecting among them. This process can range from simple choices, such as deciding what to wear, to complex decisions, like choosing a major in college or a career path. The complexity of the decision often dictates the approach we use, which can be broadly categorized into two types: automatic and controlled decision-making.
Automatic decision-making is fast, intuitive, and relies on gut feelings...

Reason and Intuition

Reason and Intuition

The human brain processes information for decision-making using one of two routes: an intuitive system and a rational system (Epstein, 1994; popularized by Kahneman, 2011 as System 1 and System 2, respectively). The intuitive system is quick, impulsive, and operates with minimal effort, relying on emotions or habits to provide cues for what to do next, while the rational system is logical, analytical, deliberate, and methodical. Research in neuropsychology suggests that the...

Revisionist Views of Adolescent and Adult Cognition

Revisionist Views of Adolescent and Adult Cognition

A revisionist approach to Jean Piaget's theory of cognitive development has brought new insights that challenge and reinterpret his established ideas. Piaget proposed that the formal operational stage, emerging in adolescence, represents the culmination of cognitive maturity. During this stage, individuals are said to develop abstract thinking, engage in systematic problem-solving, and show a form of egocentrism, believing others are as preoccupied with their behavior as they are...

Lazarus's Cognitive Appraisal Theory

Lazarus's Cognitive Appraisal Theory

Cognitive psychologist Richard Lazarus proposed the cognitive-mediational theory of emotions, which emphasizes how individuals' assessments of stressors significantly affect their experience of stress. According to Lazarus, the stress response is determined by a two-step appraisal process: primary appraisal and secondary appraisal. These cognitive appraisals help individuals evaluate the potential impact of a stressor and determine the adequacy of their coping resources.
Primary Appraisal:...