Trauma Scoring And Preventive Antibiotics In The Occurrence Of Sepsis And Trauma Care

Objective To investigate the application of the trauma scoring system(ISS, NISS, SIRS, mSIRS and SPSPT) in the assessment of the outcomes oftrauma care and the occurrence of post-traumatic sepsis, in order to offer arapid and reliable tool for clinical assessment. To investigate the effect ofpreventive antibiotics on the occurrence of sepsis to promote the rational useof preventive antibiotics.Methods (1) To retrospectively analyze the clinical data of patientswith trauma and treated at Chongqing Emergency Medical Centre fromJanuary2010to January2012. The ISS, NISS, SIRS, mSIRS and SPSPTwere respectively calculated, and the outcomes of trauma care and theincidence of post-traumatic sepsis were predicted simultaneously.(2)149cases of severe multiple trauma with the ISS≥16were selected. The data,including the administration time of preventive antibiotics, course andswitching of therapy, was collected to analyze their effects on sepsis.Results (1) Trauma scoring: SPSPT and mSIRS showed equal(P>0.05， Z=0.029) accuracy in the prediction of the incidence ofpost-traumatic sepsis, but both higher than SIRS, NISS and ISS. While SPSPT could further differentiate the severity of sepsis (P=0.019) andshowed a higher accuracy in the prediction of mortality than mSIRS, SIRS,NISS and ISS.(2) The prophylactic use of antibiotics:①the administrationtime of the no sepsis group [(5.3±2.7)h] was significantly（P<0.001）earlierthan that of the sepsis group [(10.5±4.0)h] and severe sepsis group[(11.8±4.9)h]. According to the administration time, patients were dividedinto <3h group (0h～3h),>3h group (>3h～9h) and>9h group (>9h～22h).The incidences of sepsis were11.54%,74.63%and94.64%respectively.The>3h group and>9h group showed significantly higher incidences ofsepsis than <3h group（P<0.001）.②The ROC area of the administrationtime in the prediction of sepsis was0.887and the sensitivity and specificitywere84.9%and84.1%respectively. The cut-off point was6.5h after trauma.<6.5h group showed significantly lower incidence of sepsis than>6.5hgroup (31.37%vs.91.83%, P<0.001).③According to the course ofpreventive antibiotics, patients were divided into0～3d group,4～5d group,6～7d group and>7d group. The incidences of sepsis were60.87%，59.46%，65.00%and89.80%respectively. The>7d group showedsignificantly higher incidences of sepsis than other three groups（P<0.001）.④According to the replacement of antibiotics,no replacement group showedsignificantly lower incidence of sepsis than replacement group (65.49%vs.88.89%, P<0.001). No replacement group showed significantly lowerduration of SIRS than replacement group(3.3±2.2d vs.4.4±2.6d, t=2.8,P=0.006). No replacement group showed significantly lower score ofmSIRS than replacement group(4.4±1.2vs.4.9±1.0, t=2.5,P=0.013).Conclusions (1) All of ISS, NISS, SIRS, mSIRS and SPSPT work wellin the evaluation of the outcomes of trauma care and the incidence of post-traumatic sepsis. SPSPT is better to predict the occurrence of trauma patientswith sepsis and treatment outcome.At the same time, SPSPT coulddifferentiate the high-risk groups for sepsis and severe sepsis to facilitateearly treatment and improve the treatment level.(2) The post-traumaticpreventive use of antibiotics need to be early, appropriate course and types.So it can reduce the incidence of sepsis and promotes the rational use ofpreventive antibiotics.