当前位置: X-MOL 学术World J. Emerg. Surg. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
The application of the WSES classification system for open pelvic fractures—validation and supplement from a nationwide data bank
World Journal of Emergency Surgery ( IF 8 ) Pub Date : 2022-05-27 , DOI: 10.1186/s13017-022-00434-y
Pei-Hua Li , Ting-An Hsu , Yu-Chi Kuo , Chih-Yuan Fu , Francesco Bajani , Marissa Bokhari , Justin Mis , Stathis Poulakidas , Faran Bokhari

Open pelvic fractures are rare but complex injuries. Concomitant external and internal hemorrhage and wound infection-related sepsis result in a high mortality rate and treatment challenges. Here, we validated the World Society Emergency Society (WSES) classification system for pelvic injuries in open pelvic fractures, which are quite different from closed fractures, using the National Trauma Data Bank (NTDB). Open pelvic fracture patients in the NTDB 2015 dataset were retrospectively queried. The mortality rates associated with WSES minor, moderate and severe injuries were compared. A multivariate logistic regression model (MLR) was used to evaluate independent factors of mortality. Patients with and without sepsis were compared. The performance of the WSES classification in the prediction of mortality was evaluated by determining the discrimination and calibration. A total of 830 open pelvic fracture patients were studied. The mortality rates of the mild, moderate and severe WSES classes were 3.5%, 11.2% and 23.8%, respectively (p < 0.001). The MLR analysis showed that the presence of sepsis was an independent factor of mortality (odds of mortality 9.740, p < 0.001). Compared with patients without sepsis, those with sepsis had significantly higher mortality rates in all WSES classes (minor: 40.0% vs. 3.1%, p < 0.001; moderate: 50.0% vs. 9.1%, p < 0.001; severe: 66.7% vs. 22.2%, p < 0.001). The receiver operating characteristic (ROC) curve showed an acceptable discrimination of the WSES classification alone for evaluating the mortality of open pelvic fracture patients [area under curve (AUC) = 0.717]. Improved discrimination with an increased AUC was observed using the WSES classification plus sepsis (AUC = 0.767). The WSES guidelines can be applied to evaluate patients with open pelvic fracture with accurate evaluation of outcomes. The presence of sepsis is recommended as a supplement to the WSES classification for open pelvic fractures.

中文翻译:

WSES分类系统在开放性骨盆骨折中的应用——来自全国数据库的验证与补充

开放性骨盆骨折是罕见但复杂的损伤。伴随的外部和内部出血以及伤口感染相关的败血症导致高死亡率和治疗挑战。在这里,我们使用国家创伤数据库 (NTDB) 验证了世界紧急协会 (WSES) 对开放性骨盆骨折中骨盆损伤的分类系统,这与闭合性骨折完全不同。回顾性调查了 NTDB 2015 数据集中的开放性骨盆骨折患者。比较了与 WSES 轻度、中度和重度损伤相关的死亡率。多变量逻辑回归模型(MLR)用于评估死亡率的独立因素。比较有和没有脓毒症的患者。通过确定区分和校准来评估 WSES 分类在预测死亡率中的性能。共研究了 830 名开放性骨盆骨折患者。轻度、中度和重度 WSES 级别的死亡率分别为 3.5%、11.2% 和 23.8%(p < 0.001)。MLR 分析表明,脓毒症的存在是死亡率的独立因素(死亡率 9.740,p < 0.001)。与没有脓毒症的患者相比,脓毒症患者在所有 WSES 类别中的死亡率均显着升高(轻微:40.0% vs. 3.1%,p < 0.001;中度:50.0% vs. 9.1%,p < 0.001;严重:66.7% vs. . 22.2%, p < 0.001)。受试者工作特征 (ROC) 曲线显示,单独使用 WSES 分类评估开放性骨盆骨折患者的死亡率是可以接受的[曲线下面积 (AUC) = 0.717]。使用 WSES 分类加脓毒症(AUC = 0.767)观察到随着 AUC 增加而改善的辨别力。WSES 指南可用于评估开放性骨盆骨折患者并准确评估结果。脓毒症的存在被推荐作为开放性骨盆骨折 WSES 分类的补充。
更新日期:2022-05-27
down
wechat
bug