基于院前动态生命体征的创伤性脑损伤患者院内死亡相关因素分析：一项单中心回顾性研究

Analysis of factors associated with in-hospital death of patients with traumatic brain injury based on prehospital dynamic vital signs: a single-center retrospective study

摘要

目的 基于院前监测的短时动态生命体征数据,探讨院前短时动态生命体征指标与创伤性脑损伤（TBI）患者院内死亡的关联。方法 回顾性纳入2020年1月1日至2024年12月31日由救护车转运至皖南医学院第二附属医院的TBI患者,提取院前生命体征的初始值、最小值、最大值及短时动态变化趋势指标。采用单因素及多因素Logistic回归分析院前生命体征指标与院内死亡的关系,并绘制受试者操作特征曲线（ROC）,评价独立相关因素及其联合指标对院内死亡的区分能力。结果 研究共纳入TBI患者263例,其中院内死亡42例（15.97%）。多因素Logistic回归分析显示,呼吸频率（OR=1.358,95%CI：1.004～1.838,P=0.047）、SpO₂-min（OR=0.498,95%CI：0.277～0.895,P=0.020）、收缩压变化趋势_Z（OR=0.028,95%CI：0.004～0.194,P＜0.001）、SpO₂变化趋势_Z（OR=0.055,95%CI：0.010～0.302,P＜0.001）及格拉斯哥昏迷评分（GCS）变化趋势_Z（OR=0.364,95%CI：0.138～0.956,P=0.040）为院内死亡的独立相关因素。基于多因素Logistic回归模型预测概率构建的联合指标ROC曲线下面积（AUC）为0.992（95%CI：0.979～1.000,P＜0.001）,且高于各预测因子,差异具有统计学意义（P＜0.05）。校准曲线及决策曲线分析（DCA）均提示预测模型具有较好的校准能力及临床应用价值。结论 院前短时动态生命体征变化趋势与TBI患者院内死亡密切相关,较单一时间点的预测指标可能提供更多病情评估信息。多项院前动态指标联合后对院内死亡具有较好的区分能力,可为院前高危患者的早期识别提供一定参考。

Abstract

Objective This study aimed to investigate the association between prehospital short-term dynamic vital-sign indicators and in-hospital mortality in patients with TBI based on prehospital monitored dynamic vital-sign data. Methods In this retrospective study, patients with TBI who were transported by ambulance to the Second Affiliated Hospital of Wannan Medical College between January 1, 2020, and December 31, 2024, were included. Initial, minimum, and maximum values of prehospital vital signs, as well as their short-term dynamic trend indicators, were extracted. Univariate and multivariable Logistic regression analyses were performed to examine the associations between prehospital vital-sign indicators and in-hospital mortality. Receiver operating characteristic (ROC) curves were plotted to evaluate the discriminative ability of independent factors and their combined model for in-hospital mortality. Results A total of 263 patients with TBI were included, of whom 42 (15.97%) died during hospitalization. Multivariable Logistic regression analysis showed that respiratory rate (OR=1.358, 95%CI: 1.004-1.838, P=0.047), minimum SpO₂ (OR=0.498, 95%CI: 0.277-0.895, P=0.020), standardized systolic blood pressure trend (OR=0.028, 95%CI: 0.004-0.194, P<0.001), standardized SpO₂ trend (OR=0.055, 95%CI: 0.010-0.302, P<0.001), and standardized Glasgow Coma Scale (GCS) trend (OR=0.364, 95%CI: 0.138-0.956, P=0.040) were independently associated with in-hospital mortality. The area under the receiver operating characteristic curve (AUC) for the combined predictor based on the multivariable Logistic regression model was 0.992 (95%CI: 0.979-1.000, P<0.001), and was significantly higher than those of individual predictors (P<0.05). Calibration curves and decision curve analysis (DCA) indicated that the prediction model demonstrated good calibration and potential clinical utility. Conclusion Short-term dynamic changes in prehospital vital signs were closely associated with in-hospital mortality in patients with TBI and may provide more prognostic information than single time-point indicators. The combination of multiple prehospital dynamic indicators showed good discriminative ability for in-hospital mortality and may help facilitate the early identification of high-risk patients in the prehospital setting.

关键词

创伤性脑损伤 / 院前急救 / 动态生命体征 / 院内死亡

Key words

traumatic brain injury / prehospital emergency care / dynamic vital signs / in-hospital mortality

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基金资助

安徽省卫生健康科研项目(2024Aa10038)

安徽省教育厅自然科学研究项目(2025AHGXZK31460)