適切な戦略的意思決定のための修正された致命的トリアード基準の外部検証
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.
重度のトラウマ患者の28日間の死亡率の予測を改善しました. これらの更新された基準は,重要な治療戦略を導くために従来の方法よりも優れた感度と特異性を提供します.
科学分野:
- トラウマ・クリティカルケア
- 予測モデリング
- 臨床的意思決定支援
背景:
- トラウマに対する従来の"致命的三角"の基準は 戦略的意思決定に限られている
- 多中心研究データに基づいて,修正された致死性トリアード基準が以前提案されました.
- ポジティブな改訂基準: 1つの主要な基準 (FDP>90 μg/mL) または2つのマイナー基準 (ベース超過<-3 mEq/Lまたは温度<36°C).
研究 の 目的:
- 外部で検証する 致命的なトライアードの基準を
- 重傷患者の28日間の死亡率に関する改訂基準の予測性能を評価する.
主な方法:
- 日本の25の施設の重傷患者1,177人の分析 (2018年4月 - 2019年3月).
- 改定基準の計算の対象となる患者の割合の評価
- 受信機の動作特性曲線と校正グラフを用いた予測精度の評価.
主要な成果:
- 改訂された基準は,患者の65. 4%で計算可能であった.
- 改訂された基準は,28日間の死亡率で80. 6%の感度と64. 4%の特異性を示した.
- 改訂された基準のROC曲線の下の面積 (0.77) は従来の基準 (0.68) を上回りました.
- カリブレーショングラフは予測された死亡率と観測された死亡率の高い一致を示した.
結論:
- 重度のトラウマにおける28日間の死亡率を予測するのに臨床的に十分な感度と適切な特異性を示しています.
- これらの基準は,トラウマケアにおける重要な治療戦略の実施に役立つ指標です.
- 外部検証は,トラウマ患者の管理において,修正された致命的トリアード基準の有用性を支持しています.
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