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确定血静的时间与固体器官损伤患者的死亡率的关联
Michaela Wycoff1, Thomas P Hoag2, Raymond I Okeke2
1General Surgery, MercyOne Des Moines Medical Center, Des Moines, USA.
Cureus
|October 19, 2023
概括
在创伤患者中,由于偏差而导致的延迟血静可能会改善固体器官损伤的生存率. 这项研究表明,延迟根据严重程度对患者进行分类,而不是延迟治疗的好处.
科学领域:
- 创伤外科 手术 创伤外科
- 外科手术的结果
- 医学统计 医学统计
背景情况:
- "黄金时刻"概念传统上强调了立即的创伤护理.
- 到终身护理的时间对生存的实际影响,特别是对固体器官损伤的实际影响,仍然不清楚.
- 生存率和根据严重程度的指示偏差使治疗时间的分析变得复杂.
研究的目的:
- 量化固体器官损伤患者的最终血液静止时间和死亡率之间的关联.
- 评估生存偏差和症状严重程度偏差对这种关系的影响.
- 模拟治疗延迟和患者存活率之间的非线性关联.
主要方法:
- 使用美国外科医生学院国家创伤数据库 (2017-2019) 进行的回顾性队列研究.
- 对肝脏,或损伤需要在六小时内静血的患者进行分析.
- 考克斯比例危险回归和多变量逻辑回归与受限制的立方线;模拟数据建模用于偏差分析.
主要成果:
- 调整后的死亡危险比率随着血液静止时间的每分钟增加 (0.9959) 略有下降.
- 使用受限制立方线的非线性模型提供了比线性模型更好的匹配.
- 模拟数据表明,生存率和根据严重程度的指示偏差在延迟治疗时会产生明显的生存益处.
结论:
- 观察到的降低死亡率与延迟血液静止的相关性可能是混偏见的结果,而不是真正的治疗益处.
- 延迟治疗似乎与更好的生存率相关,因为危急病患者首先接受治疗,从而扭曲了数据.
- 在回顾性研究中消除这些偏差是具有挑战性的,但研究结果可能有助于在不可避免的延迟后预测患者的敏度.
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