| Objective: Discussion the best predictive score index for predicting mortality in critically ill trauma patients, provides a simple method for clinical score.Methods: The data of 394 traumatic patients admitted to intensive care unit(ICU) of Xinan Hospital,the Third Military Medical University,Daping Hospital,the Third Military Medical University and Affiliated Hospital Of Zunyi Medical College from January 2014 to December 2014 were retrospectively analyzed. The patients were divided into survivors(n=330) and non-survivors(n=64). Two groups of patients were recorded sex, age,respiratory rate,heart rate,systolic blood pressure after admission,the worst value of serum creatinine(SCr), white blood cell count(WBC), platelet count(PLT), hematocrit(HCT)within 24 h after Admission. Confirmed acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score, Glasgow coma Scale(GCS) score, sequential organ failure assessment(SOFA), systemic inflammatory response syndrome(SIRS) score, injury severity score(ISS) within 24 h, whether the emergency surgery or emergency intubation occured within 24 h, the course of sepsis, and clinical outcomes. Each observed indicators were analyzed by univariate analysis, factors leading to death were further analyzed by logistic regression, risk factors to critical trauma patients were selected, and meaningful indicators to be assigned, to calculate the warning score of death; Draw receiver operating characteristic curve(ROC), evaluated the predictive value of the warning score of death in critically ill trauma patients.Results: Compared with the survival group, age(P = 0.016),SCr(P = 0.011), APACHEⅡscore, SOFA score(P <0.001) and emergent intubation and the ratio of occurrence of sepsis(P <0.001) of non- survival group were significantly increased; PLT(P = 0.001), GCS score(P <0.001) was significantly lower than survival group; The difference of emergency surgery,sex,respiratory rate, heart rate,systolic blood pressure, WBC, HCT, SIRS, ISS score in two groups showed no significance(P>0.05).The indicators that the univariate analysis were statistically significant into multivariate logistic regression analysis, the index into the regression model were age≥65 years, APACHEⅡ≥21 points, GCS <6 points, severe sepsis or septic shock, assigning scores were 1.0 points, 1.5 points, 1.5 points, 1.5points, 2.0 points,respectively, therefore, warning score of death included these five indicators. ROC curve analysis showed: the area under ROC curve(AUC) of warning score of death predicting mortality in critically ill trauma patients was 0.867, significantly higher than the APACHEⅡ score(P = 0.022) and the GCS score(P = 0.001).Conclusion: Age≥65 years, APACHEⅡ≥21 points, GCS <6 points, severe sepsis or septic shock were risk factors of death in critically ill trauma patients,they can serve as warning score of death in critically ill trauma patients, it can be much better to predict mortality than any kind of score in critically ill trauma patients. |
