امروز : چهارشنبه 28 آذر ماه 1397
ساعت:
پایگاه آموزشی مقابله با مصدومیت - تروما

عملکرد سیستم‌های نمره‌دهی فیزیولوژی در پیش بینی مرگ و میر کودکان در بیمارستان بر اثر تروما

عملکرد سیستم‌های نمره‌دهی فیزیولوژی در پیش بینی مرگ و میر کودکان در بیمارستان بر اثر تروما: یک مطالعه مشاهده‌ای آینده‌نگر.

Performance of physiology scoring systems in prediction of in-hospital mortality of traumatic children: A prospective observational study.


Nakhjavan-Shahraki B1, Yousefifard M2, Faridaalaee G3, Shahsavari K4, Oraii A5, Hajighanbari MJ6, Karimi P7, Mahdizadeh F8, Abiri S9, Hosseini M10.

Author information
1
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
2
Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
3
Department of Emergency Medicine, Maragheh University of Medical Sciences, Maragheh, Iran.
4
Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
5
Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
6
Department of Emergency Medicine, Hafte Tir Hospital, Iran University of Medical Sciences, Tehran, Iran.
7
Department of Emergency Medicine, Robatkarim Hospital, Iran University of Medical Sciences, Tehran, Iran.
8
Department of Emergency Medicine, Ilam University of Medical Sciences, Ilam, Iran.
9
Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.
10
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

BACKGROUND:

This study is designed to compare the value of four physiologic scoring systems of rapid acute physiology score (RAPS), rapid emergency medicine score (REMS), Worthing physiology scoring system (WPSS) and revised trauma score (RTS) in predicting the in-hospital mortality of traumatic children brought to the emergency department.

METHOD:
We used the data gathered from six healthcare centers across Iran between the April-October 2016. Included patients were all children with trauma. Patients were assessed and followed until discharge. Moreover, patients were divided to two groups of died and alive, and discriminatory power and general calibration of models in prediction of in-hospital mortality were compared.

RESULTS:
Data was gathered from 814 children (average age of 11.65 ± 5.36 years, 74.32% boys). Highest measured area under the curve was for RAPS and REMS with 0.986 and 0.986, respectively. Areas under the curve of WPSS and RTS were 0.920 and 0.949, respectively (p = 0.02). Sensitivity and specificity of RAPS were 100.0 and 95.05, respectively. These amounts for REMS were 100.0 and 94.04, respectively. Two models of RTS and WPSS had the same sensitivity of 84.62. Specificity of these two was 98.22 and 96.95, respectively. Three models of RAPS, REMS and RTS had proper calibrations in predicting mortality; however, it seems that WPSS overestimates the mortality in high risk patients.

CONCLUSION:
As calculations of RAPS is easier than REMS and their proper calibrations, it seems that RAPS is the best physiologic model in predicting in-hospital mortality and classifying in traumatic children based on severity of injury. However, further validation of the recommended score is essential before implementing them into routine clinical practice.


 نوشته شده توسط : Admin      در تاريخ : 1396/09/10        ساعت : 13:59     

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