急诊入院多发伤患者早期死亡的危险因素分析及预警模型构建  

Analysis of risk factors for early mortality and development of an early warning model in emergency department patients with polytrauma

作　　者：李佳雯 赵继军 田娜[1,2] 李博 王仝选[1] 马磊 LI Jiawen;ZHAO Jijun;TIAN Na;LI Bo;WANG Tongxuan;MA Lei(Emergency Department,General Hospital of Ningxia Medical University,Yinchuan Ningxia 750000,China)

机构地区：[1]宁夏医科大学总医院,宁夏银川750000 [2]宁夏医科大学,宁夏银川750004

出　　处：《中国急救复苏与灾害医学杂志》2024年第8期1030-1033,1116,共5页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的 分析多发伤患者急诊入院后早期死亡危险因素,构建可早期评估死亡风险的列线图预警模型。方法 回顾性分析宁夏医科大学总医院急诊科收治的785例多发伤患者,以随机数字法(3∶1)分为建模组和验证组,对建模组采用Logistics回归分析多发伤患者早期死亡的危险因素,使用R语言软件绘制列线图并评价。结果 多因素Logistics回归分析结果显示,年龄、MEWS评分、GCS评分、血糖和PT是急诊入院多发伤患者早期死亡的独立危险因素(OR值分别为1.042、1.554、0.705、1.094、1.144,均P<0.05)。构建列线图模型,结果显示预测模型具有良好区分度(AUC为0.955,95%CI:0.934~0.976),Hosmer-Lemeshow拟合优度检验P=0.828;外部验证AUC为0.942(95%CI:0.904~0.980)。校准曲线提示预测模型具有良好一致性。DCA曲线提示预测模型具有较高的净收益和临床有效性。结论 列线图模型具有良好的预测效能,为急诊入院多发伤患者的早期评估提供了良好的参考依据。Objective To analyze the risk factors for early mortality after emergency department admission in polytrauma patients,and construct a nomogram for early assessment of mortality risk.Methods This was a retrospective analysis of 785 polytrauma patients admitted to the emergency department of the General Hospital of Ningxia Medical University.Patients were randomly divided into modeling and validation groups at 3∶1 ratio.Logistic regression analysis was used to identify risk factors for early mortality in the modeling group.A nomogram model was developed and validated using the R software.Results Multivariate logistic regression analysis demonstrated that age,MEWS score,GCS score,blood glucose,and PT were independent risk factors for early mortality in emergency department polytrauma patients(OR=1.042,1.554,0.705,1.094,1.144,P<0.05).The constructed nomogram model showed good discrimination,with an AUC of 0.955(95%CI:0.934-0.976).The Hosmer-Lemeshow goodness of fit test P=0.828.External validation AUC was 0.942(95%CI:0.904-0.980).The calibration curve suggested the prediction model had good consistency.The DCA curve indicated the prediction model had high net benefit and clinical utility.Conclusion The nomogram model showed good predictive performance,and provides a good reference for early assessment of emergency department admitted polytrauma patients.

关 键 词：多发伤 急诊 早期死亡 危险因素 列线图 

分 类 号：R459.7[医药卫生—急诊医学]