Email Alert | RSS

北京大学学报（医学版） ›› 2024, Vol. 56 ›› Issue (6): 1065-1068. doi: 10.19723/j.issn.1671-167X.2024.06.019

• 论著 • 上一篇    下一篇

影响高处坠落伤患者创伤严重程度评分的院前因素

杜哲, 王天兵*()   

  1. 北京大学人民医院创伤救治中心，创伤救治与神经再生教育部重点实验室，国家创伤医学中心，北京 100044
  • 收稿日期:2022-03-01 出版日期:2024-12-18 发布日期:2024-12-18
  • 通讯作者: 王天兵 E-mail:wangtianbing@pkuph.edu.cn

Prehospital factors influencing patients' injury severity score who fell from height

Zhe DU, Tianbing WANG*()   

  1. Trauma Medicine Center, Peking University People's Hospital; Key Laboratory of Trauma and Neural Regeneration Mi-nistry of Education; National Center for Trauma Medicine of China, Beijing 100044, China
  • Received:2022-03-01 Online:2024-12-18 Published:2024-12-18
  • Contact: Tianbing WANG E-mail:wangtianbing@pkuph.edu.cn

RICH HTML

   

PDF (PC)

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

表1

患者一般资料"

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)

表2

影响ISS评分的单因素分析"

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

表3

影响ISS评分的多因素分析"

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
1 Icer M , Guloglu C , Orak M , et al.Factors affecting mortality caused by falls from height[J].Ulus Travma Acil Cerrahi Derg,2013,19(6):529-535.
doi: 10.5505/tjtes.2013.77535
2 Fujii M , Shirakawa T , Nakamura M , et al.Factors influencing the injury severity score and the probability of survival in patients who fell from height[J].Sci Rep,2021,11(1):15561.
doi: 10.1038/s41598-021-95226-w
3 Loizou E , Bouamra O , Dark P , et al.Comparing the systolic blood pressure (SBP) and pulse rate (PR) in injured children with and without traumatic brain injury[J].Resuscitation,2010,81(4):418-421.
doi: 10.1016/j.resuscitation.2009.12.017
4 Casati A , Granieri S , Cimbanassi S , et al.Falls from height. Analysis of predictors of death in a single-center retrospective study[J].J Clin Med,2020,9(19):3175.
5 Piazzalunga D , Ruberta F , Fugazzola P , et al.Suicidal fall from heights trauma: Difficult management and poor results[J].Eur J Trauma Emerg Surg,2020,46(2):383-388.
doi: 10.1007/s00068-019-01110-8
6 Venkatesh VT , Kumar MV , Jagannatha SR , et al.Pattern of ske-letal injuries in cases of falls from a height[J].Med Sci Law,2007,47(4):330-334.
doi: 10.1258/rsmmsl.47.4.330
7 Liu CC , Wang CY , Shih HC , et al.Prognostic factors for mortality following falls from height[J].Injury,2009,40(6):595-597.
doi: 10.1016/j.injury.2008.11.014
8 Lohanathan A , Hazra D , Jyothirmayi CA , et al.An elucidation of pattern of injuries in patients with fall from height[J].Indian J Crit Care Med,2020,24(8):683-687.
doi: 10.5005/jp-journals-10071-23520
9 Faggiani M , Aragno E , Aprato A , et al.Falls from height: Orthopaedic and psychiatric evaluation[J].Acta Biomed,2020,91(4-S):79-84.
[1] 晋菲斐, 周靖, 黄伟, 王天兵. 美国外科医师学会第七版"创伤患者最佳救治资源(2022年标准)"主要更新内容解析[J]. 北京大学学报（医学版）, 2024, 56(6): 1137-1142.
[2] 寇玉辉, 殷晓峰, 王天兵, 姜保国. 严重创伤救治规范的研究与推广[J]. 北京大学学报（医学版）, 2015, 47(2): 207-210.
[3] 安帅, 王天兵, 张培训, 殷晓峰, 范达, 张进军, 姜保国. 北京城区院前救治的道路交通损伤特点分析[J]. 北京大学学报（医学版）, 2014, 46(5): 777-781.
[4] 黄广林, 满立波, 王海, 王建伟, 翟建坡, 朱晓斐, 周宁, 徐啸. 使用尿道旋切刀治疗女性尿道闭锁[J]. 北京大学学报（医学版）, 2014, 46(4): 574-577.
[5] 姜保国, 王天兵. 八年制医学生骨科全病程管理教育模式[J]. 北京大学学报(医学版), 2012, 44(6): 977-978.
[6] 刘文华, *, 李丽萍, 周指明, 梁锦峰, 朱瑶, 王钢, 邓少杰. 深圳市宝安区2004年至2011年道路交通事故伤的特点分析[J]. 北京大学学报(医学版), 2012, 44(6): 901-904.
[7] 张培训, 寇玉辉, 韩娜, 党育, 薛峰, 王天兵, 徐海林, 陈建海, 杨明, 卢浩, 殷晓峰, . 可降解生物套管小间隙套接法修复周围神经损伤的临床观察[J]. 北京大学学报(医学版), 2012, 44(6): 842-846.
[8] 王艳华, 彭建平, 张振军, 张殿英, 王静, 王天兵, 张培训, 张宏波, 姜保国, . 北京市2009年道路交通事故伤的特点分析[J]. 北京大学学报（医学版）, 2011, 43(5): 735-738.
[9] 姜保国. 创伤骨科进展[J]. 北京大学学报（医学版）, 2011, 43(5): 645-646.
[10] 陈伟豪, 关志忱. 氯胺酮相关性泌尿系统损伤 [J]. 北京大学学报（医学版）, 2011, 43(4): 636-639.
[11] 李宏, 李淳德. 儿童颈脊髓锐器伤一例[J]. 北京大学学报（医学版）, 2007, 39(4): 385-387.
[12] 林琴, 王广发, 汤秀英, 邹水兰. 地塞米松对内毒素致急性肺损伤大鼠肺的保护作用[J]. 北京大学学报（医学版）, 2006, 38(4): 393-396.
[13] 蔡志明, 朱辉, 龙云, 宋博, 张蒂荣, 马雅, 龙道畴. 阴茎大部分缺损功能性修复术的研究[J]. 北京大学学报（医学版）, 2004, 36(6): 587-590.
Viewed
Full text