基于急诊CT的创伤性颈髓损伤危险因素研究
作者:
作者单位:

南京医科大学第一附属医院

基金项目:

国家自然科学基金青年科学基金项目;江苏省基础研究计划自然科学基金青年基金项目;江苏省人民医院临床能力提升工程项目


Research on Risk Factors of Traumatic Cervical Spinal Cord Injury Based on Emergency CT
Fund Project:

National Natural Science Foundation of China - Youth Science Foundation Project; Natural Science Foundation of Jiangsu Province Basic Research Program - Youth Fund Project; Clinical Capability Enhancement Project of Jiangsu Province Hospital

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    摘要:

    目的:基于急诊CT检查评估多发伤患者中创伤性脑损伤(traumatic brain injury,TBI)合并创伤性颈髓损伤(Traumatic cervical spinal cord injury,TCSCI)的危险因素以及其对预后的影响。方法:回顾性分析2020年01月至2022年12月南京医科大学第一附属医院急诊接诊时不排除TCSCI的218例多发创伤患者资料,根据入院后颈椎MRI结果,确定是否存在TCSCI,分为TCSCI和非TCSCI组。通过多因素Logistic回归分析,筛选出独立危险因素构建受试者工作特征(the receiver operating characteristic,ROC)曲线预测模型并进行内部验证。结果:69例(31.7%)患者合并TCSCI,多因素Logistic回归分析结果显示,较高的头部简明损伤评分(head abbreviated injury scale,hAIS)(OR=1.552,95%CI:1.101~2.188)、下颈椎损伤分类(sub-axial injury classification,SLIC)评分(OR=1.235,95%CI:1.006~1.517)和截瘫症状(OR=3.810,95%CI:1.115~13.020)是TCSCI的独立危险因素。预测模型ROC曲线下面积为 0.9(95%CI:0.859~0.941),通过Hosmer?Leme?show 检验评价模型效果,提示预测模型区分度和校准度均较好。结论:hAIS、SLIC评分和截瘫症状是多发创伤患者合并TCSCI的独立危险因素,针对不排除TCSCI的多发创伤患者,进行急诊CT检查并评估hAIS、SLIC评分、截瘫症状可能有效筛选出高危TCSCI患者。

    Abstract:

    Objective: To evaluate the risk factors for traumatic brain injury (TBI) combined with traumatic cervical spinal cord injury (TCSCI) in patients with multiple traumas based on emergency CT scans, and their impact on prognosis. Methods: A retrospective analysis was conducted on the data of 218 patients with multiple traumas who were admitted to the emergency department of the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2022 and were not excluded for TCSCI. Based on the cervical MRI results after admission, the presence of TCSCI was determined, and patients were divided into TCSCI and non-TCSCI groups. Multivariate logistic regression analysis was used to screen for independent risk factors, construct a receiver operating characteristic (ROC) curve prediction model, and perform internal validation. Results: Sixty-nine patients (31.7%) had concurrent TCSCI. Multivariate logistic regression analysis showed that higher head abbreviated injury scale (hAIS) scores (OR=1.552, 95% CI: 1.101-2.188), sub-axial injury classification (SLIC) scores (OR=1.235, 95% CI: 1.006-1.517), and paraplegia symptoms (OR=3.810, 95% CI: 1.115-13.020) were independent risk factors for TCSCI. The area under the ROC curve of the prediction model was 0.9 (95% CI: 0.859-0.941). The model's performance was evaluated using the Hosmer-Lemeshow test, indicating good discrimination and calibration of the prediction model. Conclusion: hAIS, SLIC scores, and paraplegia symptoms are independent risk factors for TCSCI in patients with multiple traumas. For patients with multiple traumas who are not excluded for TCSCI, emergency CT scanning and evaluation of hAIS, SLIC scores, and paraplegia symptoms may effectively screen for high-risk TCSCI patients.

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  • 收稿日期:2024-12-06
  • 最后修改日期:2025-02-08
  • 录用日期:2025-02-21
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