影响高处坠落伤患者创伤严重程度评分的院前因素

doi:10.19723/j.issn.1671-167X.2024.06.019

摘要/Abstract

摘要：

目的: 分析严重高处坠落伤患者的临床特点，探讨影响其创伤严重程度评分(injury severity score，ISS)的院前因素。方法: 从北京大学人民医院创伤数据库中检索2018年1月至2020年12月ISS评分≥16的高处坠落伤患者的临床资料，收集患者年龄、性别，是否存在自杀倾向、精神疾病，以及坠落高度、接触介质的性质、身体着地的部位、简明损伤评分(abbreviated injury scale，AIS)、格拉斯哥昏迷评分(Glasgow coma scale，GCS)、重症监护室(intensive care unit，ICU)停留时间、是否接受手术，并统计院内死亡人数。采用单因素分析和多重线性回归模型分析上述因素与ISS评分的关系。结果: 最终纳入符合条件的患者共160例，其中男138例，女22例，平均年龄(45.56±15.85)岁，有自杀倾向者36例(22.50%)，有精神障碍者12例(7.50%)，坠落高度平均(7.20±8.33) m，接触介质软者48例(30.00%)，身体着地部位为头部40例(25.00%)、下肢26例(16.25%)、腹侧16例(10.00%)、背侧40例(25.00%)、侧方38例(23.75%)。ISS评分22.8±6.85，GCS评分13.49±3.39，ICU停留时间(9.96±8.12) d，接受手术者142例(88.75%)。本组院内死亡8例，均为头部创伤患者，院内死亡率为5.00%(8/160)。单因素分析提示影响ISS评分的主要因素为是否有自杀倾向(P=0.01)和身体着地部位(P=0.02)，多重线性回归分析表明有自杀倾向和头部撞击地面是ISS评分的影响因素。结论: 收集高处坠落伤患者在院前的信息，尤其是是否有自杀倾向、是否为头部着地，可有效预测患者受伤的严重程度，有助于提早诊断、提早护理、提早治疗，从而避免可预防的死亡，对于提高医疗服务质量有着重要意义。

关键词: 创伤和损伤, 意外跌倒, 创伤严重程度评分, 院前因素, 坠落伤

Abstract:

Objective: To analyze the clinical characteristics of patients with severe fall injury and explore the prehospital factors affecting the injury severity score (ISS). Methods: Clinical data of severe trauma patients with fall injury and ISS≥16 from January 2018 to December 2020 were retrieved from trauma database of Peking University People' s Hospital. The patients' age, gender, suicidal tendencies, psychiatric disorders, fall height, properties of the impact surface, the body part hitting the ground, abbreviated injury scale, Glasgow coma scale (GCS), length of stay in intensive care unit (ICU), operation were collected. And the in-hospital mortality were calculated. Univariate analysis and multiple linear regression models were used to analyze the relationship between the above factors and ISS. The patients' GCS, length of stay in ICU, surgery, and in-hospital mortality were collected to analyze the general clinical characteristics of patients. Results: A total of 160 patients were finally eligible, including 138 males and 22 females, with an average age of (45.56±15.85) years. Among the 160 patients, there were 36 cases (22.50%) with suicidal tendencies, 12 cases (7.50%) with psychiatric disorders. Their average fall height was (7.20±8.33) meters, and 48 cases (30.00%) hit the soft contact medium. 40 cases (25.00%) with impact on the head at the ground, lower limbs in 26 cases (16.25%), ventral in 16 cases (10.00%), dorsal in 40 cases (25.00%), lateral in 38 cases (23.75%). The patients' ISS was 22.8±6.85, GCS was 13.49±3.39, lengths of ICU stays were (9.96±8.12) days, and 142 (88.75%) patients underwent surgery, 8 in-hospital deaths were all due to head trauma, with an in-hospital mortality rate of 5.00%. Univariate analysis suggested that the main factors influencing ISS were the presence of suicidal tendencies (P=0.01) and the site of impact on the ground (P=0.02). Multiple linear regression analysis indicated that suicidal tendencies and head impact on the ground were in-fluential factors for high ISS. Conclusion: Collecting prehospital information of patients with fall injuries, such as whether they have suicidal tendencies and whether they hit the ground with their heads, can effectively predict the severity of patients' injuries, which is conducive to early diagnosis, early care, and early treatment, thus reducing preventable death.

Key words: Wounds and injuries, Accidental falls, Injury severity score, Prehospital factors, Fall injury

中图分类号:

R649.9

杜哲, 王天兵. 影响高处坠落伤患者创伤严重程度评分的院前因素[J]. 北京大学学报（医学版）, 2024, 56(6): 1065-1068.

Zhe DU, Tianbing WANG. Prehospital factors influencing patients' injury severity score who fell from height[J]. Journal of Peking University (Health Sciences), 2024, 56(6): 1065-1068.

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参考文献 9

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Items	Data
Age/years	45.56±15.85
< 18	6 (3.75)
18-65	140 (87.50)
>65	14 (8.75)
Gender
Male	138 (86.25)
Female	22 (13.75)
Suicide attempt	36 (22.50)
Psychiatric disorders	12 (7.50)
Fall height/m	7.20±8.33
< 3	30 (18.75)
3-5	64 (40.00)
>5	66 (41.25)
Properties of the impact surface
Soft	48 (30.00)
Hard	112 (70.00)
The body part hitting the ground
Head	40 (25.00)
Lower limbs	26 (16.25)
Ventral region	16 (10.00)
Dorsal region	40 (25.00)
Lateral region	38 (23.75)
ISS	22.8±6.85
AIS (head)	3.46±0.95
AIS (face)	2.60±0.55
AIS (thorax)	3.12±0.45
AIS (abdomen)	3.33±0.48
AIS (extremities)	3.33±0.58
AIS (soft tissues)	1.33±0.52
GCS	13.49 ±3.39
Length of stay in ICU/d	9.96 ±8.12
Surgery	142 (88.75)
In-hospital mortality	8 (5.00)

Items	ISS	P
Age/years		0.48
< 17	25.67±8.02
18-65	22.9±6.93
>65	20.29±5.74
Gender		0.66
Male	22.91±7.01
Female	21.91±5.96
Suicide attempt		0.01
Yes	26.67±7.67
No	21.65±6.22
Psychiatric disorders		0.29
Yes	25.67±5.61
No	22.54±6.92
Fall height/m		0.14
< 3	22.07±7.76
3-5	21.28±6.49
>5	24.55±6.56
Properties of the impact surface		0.28
Soft	24.04±6.62
Hard	22.23±6.94
The body part hitting the ground		0.02
Head	26.55±8.17
Lower limbs	22.15±7.44
Ventral region	23.38±4.37
Dorsal region	22.6±6.14
Lateral region	19.16±4.62

Model	B	SE	Beta	t	P
Constant	35.04	8.83		3.97	< 0.01
Age	-1.86	2.10	-0.10	-0.89	0.38
Gender	-0.18	2.21	-0.01	-0.08	0.94
Suicide attempt	-5.80	2.18	-0.36	-2.66	0.01
Psychiatric disorders	2.35	3.19	0.09	0.74	0.47
Fall height	1.27	1.10	0.14	1.15	0.25
Properties of the impact surface	-0.36	1.71	-0.02	-0.21	0.83
The body part hitting the ground
Lower limbs	-5.45	2.26	-0.30	-2.41	0.02
Ventral region	-5.31	2.66	-0.23	-2.00	0.04
Dorsal region	-4.37	1.97	-0.28	-2.22	0.03
Lateral region	-9.12	2.08	-0.57	-4.40	< 0.01