Development Of Evaluation Scale For Onset Of Hypothermia In Trauma Victims

Objective:1.To investigate the current situation of hypothermia treatment in emergency trauma patients,and analysis of the causes of the current situation,active prevention and treatment of hypothermia,and development of risk assessment scale to assist in its identification and prediction to provide data support.2.To develop an assessment scale for onset of hypothermia in trauma victims was applied to pre-hospital and in-hospital for 3 hours and to test the reliability and validity of the tool.To facilitate the identification and prediction of clinical hypothermia,in order to achieve early prevention,early intervention,improve the prognosis and outcome of trauma patients.Methods:1.The combination of stratified sampling and convenient sampling were used to investigate 230 medical staff in 42 hospitals in 8 provinces of China by self-made questionnaire on the current situation of hypothermia treatment of trauma patients in emergency department.To analyze the evaluation,monitoring and rewarming of trauma patients in emergency room.2.The initial risk assessment scale for traumatic hypothermia was constructed by literature review and Delphi expert correspondence,and each item value was determined by the method of optimal sequence chart.3.A clinical predictive test was carried out.The data of 91 trauma patients were collected in this study.The items were screened by Pearson correlation coefficient method,decision value and factor analysis,Cronbach’s Alpha coefficient to form the final scale.Construct validity,content validity and criterion-related validity were used to evaluate the validity of the scale,and internal consistency was used to evaluate the reliability.Results:1.Among the staffs,29.13%and 17.39%of the medical staff assessed the patients with ISS and RTS scales.39.57%of the medical staff measured the ear temperature of the traumatic patients,5.22%of the medical staff chose the measuring frequency according to the condition of patients,and 14.78%of the medical staff monitored the body temperature of the patients whose blood pressure was less than 90mmHg.13.48%,6.96%,25.22%of the medical staff will use heating blankets,electric blankets,warm infusion to the onset of hypothermia in trauma victims for rewarming;There were significant differences in the evaluation of hypothermia,measurement and active rewarming measures in trauma center(P<0.05).2.The initial scale contains 17 items.The effective questionnaires of two rounds of expert correspondence were 100%,95%,the authority degree of experts were 0.8225,0.837,and the coordination coefficient of experts were 0.335,0.626.The results of significance test indicated P<0.01.3.The final scale consisted of 11 items.The Pearson correlation coefficient method was used to delete 5 items with no statistical difference,respectively,including age,previous medical history,wet condition of clothing,anaesthesia,and pre-hospital intubation.Six items were deleted by decision method,including age,previous medical history,wet condition of clothing,anaesthesia,the use of warm-keeping appliances during transportation,and pre-hospital intubation.4.The results of exploratory factor analysis of the final scale showed that KMO value was 0.817,Bartlett’s test of sphericity was 573.959,P<0.01,which was suitable for factor analysis.Two common factors were extracted by principal component analysis,which were self-factor and external factor,respectively.The cumulative variance contribution rate was 58.171%,and the load values of each item were between 0.535 and 0.877 for the common factor,and there were no entries with loads greater than 0.4 on multiple factors and less than 0.4 on one factor.The maximum load of 100%entries is more than 0.5.Two rounds of correspondence inquiry experts are strictly in accordance with the standard of inclusion,expert opinions also tend to be consistent,so it can be considered that the scale has a good content validity.The correlation coefficient was 0.804,the area under the ROC curve was 0.924,the 95%confidence interval was 0.866-0.982,P<0.01,and the Cronbach’s Alpha coefficient was 0.875.Conclusion:1.The status of hypothermia assessment,monitoring and rewarming in trauma patients is not optimistic.It is suggested that managers should actively introduce effective equipment for clinical use,in order to improve the awareness of nursing staff and actively prevent and cure hypothermia.At the same time,it is necessary to develop the post-traumatic hypothermia risk assessment scale to facilitate the timely evaluation of the patients,to assist the monitoring of hypothermia,in order to achieve the goal of early prevention and early intervention.2.The assessment scale for onset of hypothermia in trauma victims has good reliability and validity.It can be used in clinic to assist in the identification and prediction of hypothermia in order to achieve early prevention and early intervention to improve the prognosis and outcome of trauma patients.