对适当的战略决策进行修订的致命三元标准的外部验证
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.
修订的致命三元标准改善了严重创伤患者28天死亡率的预测. 这些更新的标准提供了比传统方法更好的灵敏度和特异性,以指导关键的治疗策略.
科学领域:
- 创伤重症护理
- 预测模型
- 临床决策支持
背景情况:
- 传统的创伤标准过于具体,
- 根据多中心研究的数据,先前提出了修订的致命三元标准.
- 积极的修订标准:一个主要标准 (FDP>90 μg/mL) 或两个次要标准 (基数过量<-3 mEq/L或温度<36°C).
研究的目的:
- 在外部验证修订的致命三合一标准.
- 评估严重受伤患者28天死亡率的修订标准的预测性.
主要方法:
- 来自25个日本机构的1177名严重受伤患者的分析 (2018年4月至2019年3月).
- 评估符合修订标准计算的患者比例.
- 使用接收器操作特征曲线和校准图进行预测准确性的评估.
主要成果:
- 对于65. 4%的患者来说,修订后的标准是可计算的.
- 经过修订的标准显示,28天死亡率为80.6%的敏感性和64.4%的特异性.
- 经过修订的标准的ROC曲线下的面积 (0.77) 优于传统的标准 (0.68).
- 校准图表显示预测和观察到的死亡率之间存在很高的一致性.
结论:
- 修订后的致命三元标准显示出临床上足够的敏感性和适当的特异性来预测严重创伤的28天死亡率.
- 这些标准是实施创伤护理关键治疗策略的有价值指标.
- 外部验证支持修订的致命三元标准在创伤患者管理中的实用性.
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