A predictive model of early mortality in trauma patients.

Autor: Hampton DA; Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA. Electronic address: hampton@ohsu.edu., Lee TH; Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA., Diggs BS; Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA., McCully SP; Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA., Schreiber MA; Department of Trauma, Critical Care, and Acute Surgery, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239-3098, USA.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2014 May; Vol. 207 (5), pp. 642-7; discussion 647. Date of Electronic Publication: 2014 Jan 31.
DOI: 10.1016/j.amjsurg.2013.12.009
Abstrakt: Background: Rapid thrombelastography (rTEG) is a real-time whole-blood viscoelastic coagulation assay. We hypothesized that admission rTEG and clinical data are independent predictors of trauma-related mortality.
Methods: Prospective observational data (patient demographics, admission vital signs, laboratory studies, and injury characteristics) from trauma patients enrolled within 6 hours of injury were collected. Mann-Whitney U test and analysis of variance test assessed significance (P ≤ .05). Logistic regression analyses determined the association of the studied variables with 24-hour mortality.
Results: Seven hundred ninety-five trauma patients were enrolled, of which 55 died within 24 hours of admission. Admission variables which independently predicted 24-hour mortality were as follows: Glasgow Coma Scale ≤8, hemoglobin <11 g/dL, international normalized ratio >1.5, Ly30 >8%, and penetrating injury (P < .05). This 5-variable model's area under the receiver operator characteristic curve was .88. The Hosmer-Lemeshow goodness-of-fit test was .90.
Conclusions: This 5-variable model provides a rapid prediction of 24-hour mortality. The inclusion of rTEG Ly30 demonstrates the association of fibrinolysis with outcome and may support the early use of antifibrinolytic therapies.
(Copyright © 2014 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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