Analysis Of Prognostic Factors For Severe Multiple Trauma Patients In ICU

Objective: Multiple trauma is a serious injury, which caused by one singleinducing factor and led to the damages of two or more anatomic sites in which at leastone site endangering life or limb. As Multiple trauma great difficulty in treating, itposed serious threat to people’s life and health. This study aimed to investigate theprognostic correlation factors of severe multiple trauma patients and to provide thebases for clinical therapy by a retrospectively analysis of93cases.Methods: The present study is a retrospective study made on93patients withsevere multiple trauma(ISS score greater than or equal to16) in the ICU of SecondAffiliated Hospital of Dalian Medical University from the period from January2011toNovember2012. These patients were divided into death group and survival group. Thestudy analyzed12indexes for any significant differences: gender, age, injury severityscore(ISS), Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score,SIRS score of admission,blood lactate of admission,6h blood lactate after admission,6hlactate clearance rate, amount of blood transfused during resuscitation(more than5000ml during24h after injury), multiple organ function dysfunction syndrome(MODS), shock, surgery. Homogeneity test is used to analyze by Levene’s test. It used ttest to analyze the data of equal population variance, t’ test to analyzed the rest. Thesample number of the measurement data in the study is more than40. The testingmethod was selected according to the theoretical frequency (T), using non-correctionChi-square test when T≥5, using continuous correction of Chi-square test when1≤T<5,using fisher probabilities when T<1.The study used multivariate logistic regression tofind the independent prognostic risk factors further, and draw the receiver operatingcharacteristic curve(ROC), calculated the area under the ROC curve (AUC) andcomparing them then.Results: The number of death was27among these93cases. The mortality was 29.03%. There were statistical differences in the ISS score, APACHEⅡ score, SIRSscore of admission, lactate of admission,6h lactate after admission,6h lactate clearancerate, amount of blood transfused during resuscitation, MODS and shock(P<0.05)between death group and survival group, while there were no statistical differences inthe gender, age and surgery between these two groups. ISS score, APACHEⅡ score,6hlactate clearance rate and MODS were independenly prognostic correlation factors. TheAUC of ISS score=0.735(P=0.000), the AUC of APACHEⅡscore=0.888(P=0.000).There were statistical differences in the AUC of ISS score and APACHEⅡscore. TheAUC of6h lactate clearance rate=0.951(SE=0.023, P=0.000). The AUC of6h lactateclearance rate has statistical difference with the ISS score AUC, which has no statisticaldifference with the AUC of APACHEⅡ score.Conclusion: The mortality of severe multiple trauma patients was high. Theinchoate main cause of death was hypovolemic shock, and the terminal was MODS. ISSscore, APACHEⅡ score,6h lactate clearance rate and MODS were prognosticcorrelation factors. APACHEⅡ score and6h lactate clearance rate were the betterpredictors than ISS score.6h lactate clearance rate is operated easily and promptly, andcan predict prognosis better．...