CAJ | 학술논문

目的探讨修正创伤评分(RTS)、CRAMS评分[循环(circulation)、呼吸(respiration)、腹部创伤(abdomen)、运动(motor)、语言(speech)]及院前伤情指数(PHI)3种院前创伤评分对地震创伤伤员病情严重程度的评估作用.方法回顾性分析2013年4月20日四川芦山地震发生至4月27日由四川大学华西医院收治的地震伤员的资料,记录其初始临床信息并计算创伤严重度评分(ISS)、RTS、CRAMS及PHI评分.通过绘制受试者工作特征曲线(ROC曲线),研究3种院前创伤评分与ISS的拟合情况,并寻找其最佳截断值;通过线性相关分析,探讨ISS与3种院前创伤评分之间的相关性.结果共纳入263例地震伤员,其中ISS≥16分者86例,＜16分者177例,两组患者间男性比例(67.4％比50.8％,x2=6.477,P=0.011)、RTS评分[分:7.55(0.29)比7.84(0),U=6 825,P=0.013]和CRAMS评分[分:8(1)比9(1),U=3 977,P=0.000]差异均有统计学意义.ROC曲线分析显示,RTS、CRAMS和PHI评分的ROC曲线下面积(AUC)分别为0.547(P=0.220)、0.734(P=0.000)和0.544 (P=0.250),三者的约登指数分别为0.093、0.443和0.119,最佳截断值分别为4.9、9.5和3.5分.线性相关分析显示,RTS、CRAMS与ISS呈显著负相关(r1=-0.139,P1=0.024;r2=-0.413,P2=0.000),而PHI与ISS无相关性(r=0.071,P=0.250).结论在3种院前创伤评分方法中,CRAMS评分与ISS评分的相关性最好,可用于地震后首诊医院医生对伤员创伤严重程度的快速评估.
목적 탐토수정창상평분(RTS)、CRAMS평분[순배(circulation)、호흡(respiration)、복부창상(abdomen)、운동(motor)、어언(speech)]급원전상정지수(PHI)3충원전창상평분대지진창상상원병정엄중정도적평고작용.방법 회고성분석2013년4월20일사천호산지진발생지4월27일유사천대학화서의원수치적지진상원적자료,기록기초시림상신식병계산창상엄중도평분(ISS)、RTS、CRAMS급PHI평분.통과회제수시자공작특정곡선(ROC곡선),연구3충원전창상평분여ISS적의합정황,병심조기최가절단치;통과선성상관분석,탐토ISS여3충원전창상평분지간적상관성.결과 공납입263례지진상원,기중ISS≥16분자86례,＜16분자177례,량조환자간남성비례(67.4％비50.8％,x2=6.477,P=0.011)、RTS평분[분:7.55(0.29)비7.84(0),U=6 825,P=0.013]화CRAMS평분[분:8(1)비9(1),U=3 977,P=0.000]차이균유통계학의의.ROC곡선분석현시,RTS、CRAMS화PHI평분적ROC곡선하면적(AUC)분별위0.547(P=0.220)、0.734(P=0.000)화0.544 (P=0.250),삼자적약등지수분별위0.093、0.443화0.119,최가절단치분별위4.9、9.5화3.5분.선성상관분석현시,RTS、CRAMS여ISS정현저부상관(r1=-0.139,P1=0.024;r2=-0.413,P2=0.000),이PHI여ISS무상관성(r=0.071,P=0.250).결론 재3충원전창상평분방법중,CRAMS평분여ISS평분적상관성최호,가용우지진후수진의원의생대상원창상엄중정도적쾌속평고.
Objective To investigate the performance of revised trauma score (RTS),CRAMS score (circulation,respiration,abdomen,motor and speech) and prehospital index (PHI) on evaluation of injury severity in earthquake victims.Methods Data of victims admitted to West China Hospital of Sichuan University during the Lushan earthquake from April 20th,2013,to April 27th were retrospectively analyzed.The clinical information at admission was recorded,and the injury severity score (ISS),RTS,CRAMS and PHI were calculated.The optimal cut-off values were looked for,the comparability between the three scores and ISS score were figured out by receiver operator characteristic curve (ROC curve),and the correlation between ISS and three scores was analyzed by linear regression analysis.Results There was a total of 263 victims included in the study.ISS ≥ 16 was found in 86 cases,and ISS＜ 16 in 177 victims,and there were significant statistic differences in male ratio (67.4％ vs.50.8％,x2=6.477,P=0.011),RTS score [7.55 (0.29) vs.7.84 (0),U=6 825,P=0.013] and CRAMS scores [8 (1) vs.9 (1),U=3 977,P=0.000] between two groups.It was showed by ROC curve analysis that the area under the ROC curve (AUC) of RTS,CRAMS and PHI was 0.547 (P=0.220),0.734 (P=0.000) and 0.544 (P=0.250),and the Youden indexes of the three scores were 0.093,0.443,and 0.119,respectively.Moreover,the best cut-off values of them were 4.9,9.5 and 3.5.Linear regression analysis showed that RTS and CRAMS score showed negative correlation with ISS score (r1 =-0.139,P1 =0.024; r2=-0.413,P2=0.000),while PHI showed no relationship with it (r=0.071,P=0.250).Conclusion Of these three scoring systems,CRAMS has the best correlation with ISS,and it can be used in the prompt assessment of trauma severity in earthquake victims.