Trauma mechanism predicts the frequency and the severity of injuries in blunt trauma patients

ABSTRACT Objective: to study the correlation of trauma mechanism with frequency and severity of injuries in blunt trauma patients. Methods: retrospective analysis of trauma registry in a 15-month period was carried out. Trauma mechanism was classified into six types: occupants of four-wheeled vehicles involved in road traffic accidents (AUTO), pedestrians struck by road vehicles (PED), motorcyclists involved in road traffic accidents (MOTO), falls from height (FALL), physical assault with blunt instruments (ASSA) and falls on same level (FSL). Injuries with AIS>2 were considered severe. One-way ANOVA, Students t and Chi-square tests were used for statistical analysis, considering p<0.05 significant. Results: trauma mechanism was classified by group for 3639 cases, comprising 337 (9.3%) AUTO, 855 (23.5%) PED, 924 (25.4%) MOTO, 455 (12.5%) FALL, 424 (11.7%) ASSA and 644 (17.7%) FSL. There was significant difference among groups when comparing the Revised Trauma Score (RTS), the Injury Severity Score (ISS) and the Abbreviated Injury Scale (AIS) of the head, thorax, abdomen and extremities (p<0.001). Severe injuries in the head and in the extremities were more frequent in PED patients (p<0.001). Severe injuries to the chest were more frequent in AUTO (p<0.001). Abdominal injuries were less frequent in FSL (p=0.004). Complex fractures of the pelvis and spine were more frequent in FALL (p<0.001). Lethality was greater in PED, followed by FALL and AUTO (p<0.001). Conclusion: trauma mechanism analysis predicted frequency and severity of injuries in blunt trauma patients.摘要 研究目的：探讨钝性创伤（blunt trauma）患者的创伤机制与损伤发生频率及严重程度的相关性。 方法：对15个月期间的创伤登记数据库开展回顾性分析。将创伤机制分为六类：四轮机动车道路交通事故乘员组（AUTO）、机动车撞击行人组（PED）、摩托车手道路交通事故组（MOTO）、高处坠落组（FALL）、钝器暴力袭击组（ASSA）和平地跌倒组（FSL）。将简明损伤定级标准（Abbreviated Injury Scale, AIS）评分>2的损伤视为严重损伤。采用单因素方差分析（One-way ANOVA）、学生t检验（Students t test）和卡方检验（Chi-square tests）进行统计学分析，以P<0.05为差异具有统计学意义。 结果：本研究共纳入3639例患者并按创伤机制分组，其中AUTO组337例（9.3%）、PED组855例（23.5%）、MOTO组924例（25.4%）、FALL组455例（12.5%）、ASSA组424例（11.7%）、FSL组644例（17.7%）。各组患者的修订创伤评分（Revised Trauma Score, RTS）、损伤严重度评分（Injury Severity Score, ISS）以及头、胸、腹、四肢的AIS评分差异均具有统计学意义（P<0.001）。PED组患者的头部及四肢严重损伤发生率更高（P<0.001）；AUTO组患者的胸部严重损伤发生率更高（P<0.001）；FSL组患者的腹部损伤发生率更低（P=0.004）；FALL组患者的骨盆及脊柱复杂骨折发生率更高（P<0.001）；PED组患者的致死率最高，其次为FALL组与AUTO组（P<0.001）。 结论：创伤机制分析可有效预测钝性创伤患者的损伤发生频率与严重程度。