Background
Methods
Study design
Results
Worse outcomes of patients with RSI < 1
Variables | RSI < 1 | RSI ≧ 1 |
Odds ratio
|
p
|
---|---|---|---|---|
N = 348 |
N = 10466 |
(95 % CI)
| ||
SBP Mean (mmHg) | 90.9±29.0 | 146.0±29.7 | - | - |
HR Mean (beats/min) | 123.4±61.3 | 86.4±16.0 | - | - |
RSI Mean | 0.8±0.2 | 1.7±0.5 | - | - |
Range | 0.0−0.9 | 1.0−8.1 | - | - |
Gender | ||||
Male | 255 (73.3) | 6631 (63.4) | 1.6 (1.25–2.02) | <0.001 |
Female | 93 (26.7) | 3835 (36.6) | 0.6 (0.50–0.80) | <0.001 |
GCS | 12.1±4.0 | 14.4±2.0 | – | <0.001 |
≤8 | 69 (19.8) | 411 (3.9) | 6.1 (4.57–8.02) | <0.001 |
9–12 | 36 (10.3) | 338 (3.2) | 3.5 (2.41–4.96) | <0.001 |
≥13 | 243 (69.8) | 9717 (92.8) | 0.2 (0.14–0.23) | <0.001 |
AIS, n (%) | ||||
Head/Neck | 139 (39.9) | 2513 (24.0) | 2.1 (1.69–2.62) | <0.001 |
Face | 83 (23.9) | 1946 (18.6) | 1.4 (1.07–1.76) | 0.013 |
Thorax | 114 (32.8) | 1197 (11.4) | 3.8 (3.00–4.76) | <0.001 |
Abdomen | 100 (28.7) | 652 (6.2) | 6.1 (4.75–7.76) | <0.001 |
Extremity | 226 (64.9) | 7590 (72.5) | 0.7 (0.56–0.88) | 0.002 |
ISS, median (IQR) | 13 (5–22) | 5 (4–9) | - | <0.001 |
<16 | 192 (55.2) | 9152 (87.4) | 0.2 (0.14–0.22) | <0.001 |
16–24 | 81 (23.3) | 947 (9.0) | 3.0 (2.36–3.95) | <0.001 |
≥25 | 75 (21.6) | 367 (3.5) | 7.6 (5.74–9.96) | <0.001 |
Mortality | 34 (9.8) | 103 (1.0) | 10.9 (7.28–16.31) | <0.001 |
Ward LOS (days) | 17.0±17.8 | 8.9±9.7 | - | <0.001 |
ICU | ||||
n (%) | 168 (48.3) | 1606 (15.3) | 5.1 (4.15–6.40) | <0.001 |
LOS (days) | 12.3±19.5 | 8.6±10.2 | - | <0.001 |
Variables | RSI < 1 | RSI ≧ 1 |
Odds ratio
|
p
|
---|---|---|---|---|
N = 348 |
N = 10466 |
(95 % CI)
| ||
Physiological response, n (%) | ||||
GCS < 13 | 105 (30.2) | 749 (7.2) | 5.6 (4.41–7.13) | <0.001 |
Respiratory rate <10 or >29 | 15 (4.3) | 33 (0.3) | 14.2 (7.66–26.47) | <0.001 |
Procedures performed, n (%) | ||||
Cardiopulmonary resuscitation | 12 (3.4) | 11 (0.1) | 33.9 (14.87–77.48) | <0.001 |
Intubation | 82 (23.6) | 369 (3.5) | 8.4 (6.45–11.03) | <0.001 |
Chest tube insertion | 36 (10.3) | 172 (1.6) | 6.9 (4.74–10.06) | <0.001 |
Blood transfusion | 44 (12.6) | 264 (2.5) | 5.6 (3.99–7.85) | <0.001 |
Variables | RSI < 1 | RSI ≧ 1 |
Odds ratio
|
p
|
---|---|---|---|---|
N = 348 |
N = 10466 |
(95 % CI)
| ||
Head trauma, n (%) | ||||
Cranial fracture | 37 (10.6) | 623 (6.0) | 1.9 (1.32–2.67) | <0.001 |
Epidural hematoma (EDH) | 22 (6.3) | 401 (3.8) | 1.7 (1.09–2.64) | 0.018 |
Subdural hematoma (SDH) | 38 (10.9) | 770 (7.4) | 1.5 (1.09–2.18) | 0.013 |
Subarachnoid hemorrhage (SAH) | 51 (14.7) | 869 (8.3) | 1.9 (1.40–2.57) | <0.001 |
Intracerebral hematoma (ICH) | 14 (4.0) | 169 (1.6) | 2.6 (1.47–4.45) | 0.001 |
Cervical vertebral fracture | 11 (3.2) | 91 (0.9) | 3.7 (1.97–7.02) | <0.001 |
Maxillofacial trauma, n (%) | ||||
Orbital fracture | 3 (0.9) | 226 (2.2) | 0.4 (0.13–1.24) | 0.098 |
Nasal fracture | 6 (1.7) | 120 (1.1) | 1.5 (0.66–3.46) | 0.323 |
Maxillary fracture | 31 (8.9) | 680 (6.5) | 1.4 (0.97–2.05) | 0.074 |
Mandibular fracture | 14 (4.0) | 265 (2.5) | 1.6 (0.93–2.79) | 0.084 |
Thoracic trauma, n (%) | ||||
Rib fracture | 56 (16.1) | 833 (8.0) | 2.2 (1.65–2.98) | <0.001 |
Sternal fracture | 3 (0.9) | 14 (0.1) | 6.5 (1.86–22.69) | 0.001 |
Hemothorax | 20 (5.7) | 150 (1.4) | 4.2 (2.60–6.77) | <0.001 |
Pneumothorax | 16 (4.6) | 163 (1.6) | 3.0 (1.80–5.15) | <0.001 |
Hemopneumothorax | 30 (8.6) | 125 (1.2) | 7.8 (5.16–11.81) | <0.001 |
Lung contusion | 15 (4.3) | 111 (1.1) | 4.2 (2.42–7.28) | <0.001 |
Thoracic vertebral fracture | 14 (4.0) | 93 (0.9) | 4.7 (2.64–8.29) | <0.001 |
Abdominal trauma, n (%) | ||||
Intra-abdominal injury | 18 (5.2) | 126 (1.2) | 4.5 (2.70–7.42) | <0.001 |
Hepatic injury | 42 (12.1) | 182 (1.7) | 7.8 (5.44–11.05) | <0.001 |
Splenic injury | 26 (7.5) | 87 (0.8) | 9.6 (6.13–15.14) | <0.001 |
Retroperitoneal injury | 10 (2.9) | 12 (0.1) | 25.8 (11.06–60.07) | <0.001 |
Renal injury | 12 (3.4) | 45 (0.4) | 8.3 (4.34–15.78) | <0.001 |
Urinary bladder injury | 3 (0.9) | 17 (0.2) | 5.3 (1.56–18.32) | 0.003 |
Lumbar vertebral fracture | 14 (4.0) | 179 (1.7) | 2.4 (1.38–4.20) | 0.001 |
Sacral vertebral fracture | 7 (2.0) | 62 (0.6) | 3.4 (1.57–7.58) | 0.001 |
Extremity trauma, n (%) | ||||
Scapular fracture | 13 (3.7) | 160 (1.5) | 2.5 (1.41–4.45) | 0.001 |
Humeral fracture | 15 (4.3) | 468 (4.5) | 1.0 (0.57–1.63) | 0.886 |
Radial fracture | 28 (8.0) | 1069 (10.2) | 0.8 (0.52–1.14) | 0.188 |
Ulnar fracture | 28 (8.0) | 514 (4.9) | 1.7 (1.14–2.52) | 0.008 |
Pelvic fracture | 44 (12.6) | 269 (2.6) | 5.5 (3.91–7.70) | <0.001 |
Femoral fracture | 57 (16.4) | 842 (8.0) | 2.2 (1.67–3.00) | <0.001 |
Tibial fracture | 37 (10.6) | 768 (7.3) | 1.5 (1.06–2.13) | 0.021 |
Fibular fracture | 26 (7.5) | 425 (4.1) | 1.9 (1.26–2.88) | 0.002 |
Good prioritization of patients using the TTAS system
Variables | Triage | ||||||||
---|---|---|---|---|---|---|---|---|---|
I | II | III | IV | V | |||||
N = 623 |
N = 3333 | I vs. II |
N = 6522 | II vs. III |
N = 314 |
N = 22 | |||
Odds ratio (95 % CI)
|
p
|
Odds ratio (95 % CI)
|
p
| ||||||
Gender | 0.173 | <0.001 | |||||||
Male (n, %) | 455 (73.0) | 2344 (70.3) | 1.1 (0.94–1.38) | 3899 (59.8) | 1.6 (1.46–1.74) | 175 (55.7) | 13 (59.1) | ||
Female (n, %) | 168 (27.0) | 989 (29.7) | 0.9 (0.72–1.06) | 2623 (40.2) | 0.6 (0.57–0.69) | 139 (44.3) | 9 (40.9) | ||
ISS | |||||||||
Median (IQR) | 17 (10–25) | 8 (4–13) | <0.001 | 4 (4–9) | <0.001 | 4 (4–9) | 4 (4–9) | ||
LOS (days) | 19.3±19.8 | 11.3±11.1 | <0.001 | 7.3±7.3 | <0.001 | 7.2±7.1 | 9.0±8.5 | ||
ICU | |||||||||
n (%) | 416 (66.8) | 809 (24.3) | 6.3 (5.21–7.54) | <0.001 | 499 (7.7) | 3.9 (3.43–4.37) | <0.001 | 47 (15.0) | 3 (13.6) |
Days | 12.5±14.9 | 8.3±11.3 | <0.001 | 7.2±7.1 | 0.040 | 8.1±8.7 | 4±2.6 | ||
Mortality | 96 (15.4) | 27 (0.8) | 22.3 (14.4–34.5) | <0.001 | 14 (0.2) | 3.8 (1.99–7.25) | <0.001 | 0 (0.0) | 0 (0.0) |
Patients with RSI < 1 within levels I–III had worse outcomes
Triage: I | RSI < 1 | RSI ≧ 1 |
Odds ratio
|
p
|
---|---|---|---|---|
Variables |
N = 130 |
N = 493 |
(95 % CI)
| |
Gender | 0.990 | |||
Male (n, %) | 95 (73.1) | 360 (73.0) | 1.0 (0.65–1.55) | |
Female (n, %) | 35 (26.9) | 133 (27.0) | 1.0 (0.65–1.54) | |
ISS | ||||
Median (IQR) | 20 (12–29) | 17 (9–25) | - | 0.007 |
LOS days | 21.8±22.9 | 18.7±18.8 | - | 0.102 |
ICU | ||||
n (%) | 92 (70.8) | 324 (65.7) | 1.3 (0.83–1.92) | 0.277 |
Days | 15.5±22.9 | 11.7±11.5 | - | 0.030 |
Mortality | 26 (20.0) | 70 (14.2) | 1.5 (0.92–2.49) | 0.105 |
Triage: II | RSI < 1 | RSI ≧ 1 |
Odds ratio
|
p
|
Variables |
N = 153 |
N = 3180 |
(95 % CI)
| |
Gender | 0.025 | |||
Male (n, %) | 120 (78.4) | 2224 (69.9) | 1.6 (1.06–2.32) | |
Female (n, %) | 33 (21.6) | 956 (30.1) | 0.6 (0.43–0.95) | |
ISS | ||||
Median (IQR) | 10 (4–17) | 6 (4–13) | - | <0.001 |
LOS days | 15.0±14.3 | 11.1±10.9 | - | <0.001 |
ICU | ||||
n (%) | 61 (39.9) | 748 (23.5) | 2.2 (1.54–3.01) | <0.001 |
days | 8.8±14.8 | 8.2±11.0 | - | 0.698 |
Mortality | 7 (4.6) | 20 (0.6) | 7.2 (2.98–17.31) | <0.001 |
Triage III | RSI < 1 | RSI ≧ 1 |
Odds ratio
|
p
|
Variables |
N = 59 |
N = 6463 |
(95 % CI)
| |
Gender | 0.846 | |||
Male (n, %) | 36 (61.0) | 3863 (59.8) | 1.1 (0.62–1.78) | |
Female (n, %) | 23 (39.0) | 2600 (40.2) | 0.9 (0.56–1.61) | |
ISS | ||||
Median (IQR) | 5 (4–16) | 4 (4–9) | - | <0.001 |
LOS days | 12.2±10.4 | 7.2±7.2 | - | <0.001 |
ICU | ||||
n (%) | 15 (25.4) | 484 (7.5) | 4.2 (2.33–7.62) | <0.001 |
Days | 7.0±6.9 | 7.2±7.2 | - | 0.932 |
Mortality | 1 (1.7) | 13 (0.2) | 8.5 (1.09–66.15) | 0.041 |
Variables | Triage | ||||||||
---|---|---|---|---|---|---|---|---|---|
I | II | III | IV | V | |||||
N = 130 |
N = 153 | I vs. II |
N = 59 | II vs. III |
N = 5 |
N = 1 | |||
Odds ratio (95 % CI)
|
p
|
Odds ratio (95 % CI)
|
p
| ||||||
Gender | 0.293 | 0.010 | |||||||
Male (n, %) | 95 (73.1) | 120 (78.4) | 0.7 (0.43–1.29) | 36 (61.0) | 2.3 (1.21–4.45) | 3 (60.0) | 1 (100) | ||
Female (n, %) | 35 (26.9) | 33 (21.6) | 1.3 (0.78–2.31) | 23 (39.0) | 0.4 (0.23–0.82) | 2 (40.0) | 0 (0) | ||
ISS | |||||||||
Median (IQR) | 20 (12–29) | 10 (4–17) | <0.001 | 5 (4–16) | 0.098 | 5 (3–14) | 10 (10–10) | ||
LOS (days) | 21.8±22.9 | 15.0±14.3 | 0.002 | 12.2±10.4 | 0.169 | 4.3±9.6 | 11- | ||
ICU | |||||||||
n (%) | 92 (70.8) | 61 (39.9) | 3.7 (2.22–6.01) | <0.001 | 15 (25.4) | 1.9 (1.00–3.80) | 0.051 | 0 (0) | 0 (0) |
Days | 15.5±22.9 | 8.8±14.8 | 0.046 | 7.0±6.9 | 0.648 | -- | -- | ||
Mortality | 26 (20.0) | 7 (4.6) | 5.2 (2.18–12.47) | <0.001 | 1 (1.7) | 2.8 (0.34–23.10) | 0.324 | 0 (0) | 0 (0) |
Inaccurate prioritization of patients with RSI < 1 within levels II and III in the TTAS system
Inaccurate prioritization of patients with RSI < 1 within levels II and III in the TTAS system
Triage II | RSI < 1 | RSI > 1 |
Odds ratio
|
p
|
---|---|---|---|---|
Variables | SBP ≧ 90 |
n = 3180 |
(95 % CI)
| |
n = 86 | ||||
Gender | ||||
Male (n, %) | 72 (83.7) | 2224 (69.9) | 2.2 (1.24–3.94) | 0.006 |
Female (n, %) | 14 (16.3) | 956 (30.1) | 0.5 (0.25–0.81) | 0.006 |
ISS | ||||
Median (IQR) | 10 (4–18) | 6 (4–13) | - | <0.001 |
LOS | ||||
Days | 15.8±15.3 | 11.1±10.9 | - | 0.006 |
LOS in ICU | ||||
n (%) | 36 (41.9) | 748 (23.5) | 2.3 (1.51–3.62) | <0.001 |
Days | 10.3±18.4 | 8.2±11.0 | - | 0.499 |
Mortality | 10 (11.6) | 20 (0.6) | 20.8 (9.41–45.92) | <0.001 |