IR@PKUHSC  > 北京大学医学信息学中心
学科主题医学信息学
Current state of trauma care in China, tools to predict death and ICU admission after arrival to hospital
Kong, Guilan1; Yin, Xiaofeng2; Wang, Tianbing2; Body, Richard3; Chen, Yu-Wang4; Wang, Jing1; Cao, Liying5; Wu, Shouling5; Gao, Jingli5; Wang, Guosheng5; Hu, Yonghua1; Jiang, Baoguo2
关键词Trauma Decision support system In-hospital death ICU admission Sensitivity Specificity
刊名INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
2015-09-01
DOI10.1016/j.injury.2015.06.002
46期:9页:1784-1789
收录类别SCI
文章类型Article
WOS标题词Science & Technology
类目[WOS]Critical Care Medicine ; Emergency Medicine ; Orthopedics ; Surgery
研究领域[WOS]General & Internal Medicine ; Emergency Medicine ; Orthopedics ; Surgery
关键词[WOS]DECISION-SUPPORT-SYSTEM ; PREHOSPITAL INDEX ; FIELD TRIAGE ; VICTIMS ; RISK
英文摘要

Background: In China, a nationwide emergency system takes charge of pre-hospital emergency services, and it adopts a proximity principle to send trauma patients to the nearest hospitals. However, many severely injured patients have been sent to low level hospitals with no capability to treat severe trauma. Thus those patients with high probability of in-hospital death or intensive care unit (ICU) admission need to be identified in the emergency department (ED) for optimal utilisation of hospital resources and better patient outcomes. The purpose of the study was to develop a computerised tool to aid ED physicians′ prediction of in-hospital death and ICU admission for trauma patients after arrival to hospital.

Methods: We reviewed a sample of 1,299 trauma patients who had been directly sent to the ED at Kailuan Hospital, North China. After excluding those cases with incomplete data entry, information of 1,195 patients was employed for analysis. The primary outcome was severe trauma that either resulted in death in hospital or in ICU admission. We proposed to use a complementary approach to combine the Pre-Hospital Index (PHI), the Trauma Index (TI), and the Glasgow Coma Score (GCS) in a decision support system (DSS) to assess trauma and predict in-hospital death and ICU admission. The sensitivity, specificity, over-triage rate, and under-triage rate were used as measurements to compare system performances of the DSS with the three scoring tools.

Results: Among the 1,195 patients, 30 (2.5%) had severe trauma. The proposed DSS showed the best sensitivity (66.7%; 95% CI: 49.8-83.6%) among all the four studied tools. The TI (sensitivity 50.0%, 95% CI: 32.2-67.8%) performed slightly better than the GCS (sensitivity 46.7%, 95% CI: 28.9-64.5%), while both the TI and GCS performed better than the PHI (sensitivity 30.0%, 95% CI: 13.5-46.5%). The performance differences between the DSS and the three extant scoring tools were statistically significant.

Conclusions: The proposed DSS outperformed the extant trauma scoring systems. It has a strong potential to help ED physicians identify severe trauma, optimally utilise hospital resources, and recommend appropriate triage and treatment strategies for trauma patients that have strong possibilities for in-hospital death and ICU admission. (C) 2015 Published by Elsevier Ltd.

语种英语
WOS记录号WOS:000362412800016
引用统计
被引频次:3[WOS]   [WOS记录]     [WOS相关记录]
文献类型期刊论文
条目标识符http://ir.bjmu.edu.cn/handle/400002259/65055
专题北京大学医学信息学中心
北京大学医学部管理机构_医学部
北京大学临床肿瘤学院_麻醉科
作者单位1.Peking Univ, Peoples Hosp, Dept Trauma & Orthopaed, Beijing 100044, Peoples R China
2.Manchester Royal Infirm, Emergency Dept, Manchester M13 9WL, Lancs, England
3.Univ Manchester, Decis & Cognit Sci Res Ctr, Manchester M15 6PB, Lancs, England
4.Peking Univ, Med Informat Ctr, Beijing 100191, Peoples R China
5.Kailuan Hosp, Tangshan City 063000, Hebei Province, Peoples R China
推荐引用方式
GB/T 7714
Kong, Guilan,Yin, Xiaofeng,Wang, Tianbing,et al. Current state of trauma care in China, tools to predict death and ICU admission after arrival to hospital[J]. INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED,2015,46(9):1784-1789.
APA Kong, Guilan.,Yin, Xiaofeng.,Wang, Tianbing.,Body, Richard.,Chen, Yu-Wang.,...&Jiang, Baoguo.(2015).Current state of trauma care in China, tools to predict death and ICU admission after arrival to hospital.INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED,46(9),1784-1789.
MLA Kong, Guilan,et al."Current state of trauma care in China, tools to predict death and ICU admission after arrival to hospital".INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 46.9(2015):1784-1789.
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