The Study Of Clinical Characteristics And Prognostic Factors In Severely Injured Patients

ObjectiveTo investigate the distribution of trauma severity and analysis of prognostic risk factors for trauma patients admitted to the emergency department of Southern Theater General Hospital.To provide a reference for the treatment and prognosis evaluation of clinical trauma patients.MethodsTrauma patients admitted to the Southern Theater General Hospital from January 2017 to December 2018 and admitted to various departments(including EICU,ICU,OICU,etc.)for inpatient treatment,and then selected eligible patients for retrospective study based on the inclusion criteria.Then,collect and summarize the general information and trauma related information of each patient,including gender,age,injury mechanism,injury site,pre-hospital time,underlying disease,trauma severity score(ISS score),GCS score at admission,vital signs(systolic blood pressure,pulse,temperature,respiratory rate)at admission,laboratory test results(blood routine,biochemical and coagulation indicators)within 24 hours of admission,surgical status,use of blood products and vasoactive drugs within 24 hours,etc.Information on prognosis was also collected,including survival/death,length of stay in ICU,total length of stay in hospital,and duration of using mechanical ventilation.All patients were divided into minor injured group(ISS<16),severe injured group(ISS?16),and very severe injured group(ISS?25)according to the severity of the trauma.The differences between the groups were compared;then the trauma patients was divided into survival group and death group,we compare the differences between the two groups and analyze the prognostic risk factors of trauma patients.The patients with severe injury(ISS?25)were selected and divided into survival and death groups,and the single prognostic factors were analyzed.and single factors were included in logistic regression analysis to explore the prognostic risk factors affecting patients with severe trauma.Severely injured patients admitted within 24 hours after injury were divided into ATC group and non-ATC group,and the differences between the two groups were compared.A large number of studies have shown that approximately 25%-35%of patients with severe trauma have coagulation dysfunction when they reach the emergency department.Often it indicates a higher risk of bleeding and a worse prognosis.As fibrinogen is an important substance in the coagulation cascade,this study will also explore its relationship with the prognosis of patients with severe trauma.ResultA total of 1299 patients were included in this study,including 908 males,accounting for 69.90%,females 391,accounting for 30.1%,and their age was 47.09±18.56 years.There were 1258 cases in the survival group and 41 cases in the death group.,the overall mortality rate was 3.16%.Among them,there were 997 cases in the minor injured group(ISS<16),164 cases in the severe injured group(ISS?16),and 138 cases in the very severe injured group(ISS?25).The study found that for all trauma patients or the very severe injured patients,compared with patients in the death group,the differences are significant in the ISS score,GCS score,activated partial thromboplastin time(APTT),international standardized ratio(INR),and prothrombin time(There were statistically significant differences between PT),thrombin time(TT),fibrinogen(Fib),length of stay in ICU,and total length of stay in hospital(P<0.05).The 8 risk factors(excluding length of stay in ICU and total length of stay in hospital)in the results of the single factor analysis were included in the multivariate logistic regression analysis.The results showed that GCS and Fib were independent risk factors affecting the prognosis of the severely injured patients.GCS(OR=0.455,p<0.001),Fib(OR=0.683,p=0.022).The ROC curve results show that the area under the Fib curve is 0.935(95%CI:0.895-0.975),suggesting that the accuracy of using Fib as a prognostic indicator for patients with severe trauma is higher.ConclusionThe overall mortality rate of trauma patients in our hospital is 3.16%,but the mortality rate of severe trauma patients can reach 27.54%,and attention should be paid to the monitoring of high-risk factors for trauma death.Fibrinogen and GCS are independent risk factors that affect the prognosis of patients with severe trauma.The low fibrinogen concentration is closely related to the patient's ISS score,and is closely related to the high mortality rate and prolonged total hospital stay.Low fibrinogen concentration can be used as an indicator to predict trauma and traumatic coagulopathy.