Factors related to early and rapid assessment of in-hospital mortality among older adult trauma patients in an earthquake

doi:10.5847/wjem.j.1920-8642.2022.099

Abstract

Abstract:

BACKGROUND: There is limited evidence for emergency physicians and emergency trauma surgeons regarding the determinants of early and rapid assessment of older adult in-hospital mortality due to earthquakes. This study explored factors related to the early and rapid assessment of the mortality among older adult earthquake trauma patients (OAETPs) and created a screening model.

METHODS: Data on 7,308 OAETPs from the West China Earthquake Patients Database were analyzed retrospectively. The 35 variables that can be obtained rapidly on arrival at the hospital were collected. Least absolute shrinkage and selection operator (LASSO) regression analysis was performed. Then, the nomogram for assessing the mortality of OAETPs was constructed.

RESULTS: We identified 10 independent mortality-related factors that contributed to the in-hospital mortality of OAETPs. The 10 factors included age (odds ratio [OR]=1.061, 95% confidence interval [CI]:1.031-1.090), dementia (OR=5.146, 95%CI: 1.169-17.856), coronary heart disease (CHD; OR=23.441, 95%CI: 4.799-83.927), malignant tumor (OR=8.497, 95%CI: 3.583-17.967), deep vein thrombosis (DVT; OR=7.110, 95%CI: 1.369-27.168), chronic kidney disease(CKD; OR=11.783, 95%CI: 5.419-24.407), pulse rate (PR; OR=1.036, 95%CI: 1.022-1.048), mean artery pressure (MAP; OR=0.960, 95%CI: 0.945-0.975), Glasgow Coma Scale (GCS; OR=0.864, 95%CI: 0.760-0.972), and Triage Revised Trauma Score (T-RTS, OR=0.485, 95%CI: 0.351-0.696).

CONCLUSION: The 10 mortality-related factors could be quickly obtained on hospital arrival and should be the focal point of future earthquake response strategies regarding hospitalized older adults with trauma. A nomogram was constructed based on the factors for screening OAETPs with a higher risk of in-hospital mortality.

Key words: Trauma, Mortality, Earthquakes, Elderly patients

Hai Hu, Ni Yao, Xiao-qin Lai. Factors related to early and rapid assessment of in-hospital mortality among older adult trauma patients in an earthquake[J]. World Journal of Emergency Medicine, 2022, 13(6): 425-432.

Figures/Tables 4

Figure 1.

Table 1.

Table 2.

Figure 2.

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Code	Variables	Survivor (n=7,194)	Non-survivor (n=114)	P-value
X1	Sex
	Female	3,144 (43.7)	36 (31.58)	0.010*
	Male	4,050 (56.3)	78 (68.42)
X2	Age, year	74.83±6.95	77.99±8.95	<0.001*
X3	Arresting bleeding	51 (0.71)	1 (0.88)	0.560
X4	Assisted ventilation	1 (0.01)	0	>0.999
X5	Fixation	31 (0.43)	1 (0.88)	0.396
X6	Fluid therapy	9 (0.13)	0	>0.999
X7	Crush injury	386 (5.37)	13 (11.4)	0.005*
X8	Open wound	3,098 (43.06)	49 (42.98)	>0.999
X9	Head/neck trauma	1,454 (20.21)	37 (32.46)	0.001*
X10	Face trauma	179 (2.49)	2 (1.75)	0.844
X11	Chest trauma	2,031 (28.23)	40 (35.09)	0.107
X12	Abdomen/pelvic trauma	1,135 (15.78)	11 (9.65)	0.074
X13	Extremity trauma	4,376 (60.83)	59 (51.75)	0.049*
X14	External trauma	2,292 (31.86)	29 (25.44)	0.144
X15	Dementia	24 (0.33)	5 (4.39)	<0.001*
X16	Hypertension	665 (9.24)	9 (7.89)	0.621
X17	Diabetes	254 (3.53)	12 (10.53)	0.001*
X18	COPD	375 (5.21)	13 (11.4)	0.003*
X19	CHD	16 (0.22)	3 (2.63)	0.003*
X20	Malignant tumor	85 (1.18)	9 (7.89)	<0.001*
X21	Stroke	106 (1.47)	4 (3.51)	0.093
X22	DVT	21 (0.29)	4 (3.51)	0.001*
X23	CKD	53 (0.74)	16 (14.04)	<0.001*
X24	Liver cirrhosis	6 (0.08)	1 (0.88)	0.104
X25	Lung infection	114 (1.58)	6 (5.26)	0.011*
X26	Urinary tract infection	49 (0.68)	4 (3.51)	0.009*
X27	Bedsores	111 (1.54)	7 (6.14)	0.002*
X28	Temperature, °C	36.73±0.44	36.85±0.74	0.109
X29	RR, breaths per minute	20.10±1.89	21.56±5.20	0.003*
X30	PR, beats per minute	81.33±10.92	91.64±20.76	<0.001*
X31	SBP, mmHg	129.77±20.33	117.44±24.73	<0.001*
X32	DBP, mmHg	76.48±11.72	69.03±17.26	<0.001*
X33	MAP, mmHg	94.24±13.17	85.16±18.32	<0.001*
X34	GCS	15 (15-15)	15 (10-15)	<0.001*
X35	T-RTS	12 (12-12)	12 (10-12)	<0.001*

Variables	Code	Coefficients	S.E.	OR	95%CI	P-value
Age	X2	0.059	0.014	1.061	1.031-1.090	<0.001*
Dementia	X15	1.638	0.688	5.146	1.169-17.856	0.017*
CHD	X19	3.154	0.710	23.441	4.799-83.927	<0.001*
Malignant tumor	X20	2.140	0.407	8.497	3.583-17.967	<0.001*
DVT	X22	1.962	0.755	7.110	1.369-27.168	0.009*
CKD	X23	2.467	0.382	11.783	5.419-24.407	<0.001*
PR	X30	0.035	0.006	1.036	1.022-1.048	<0.001*
MAP	X33	-0.040	0.008	0.960	0.945-0.975	<0.001*
GCS	X34	-0.146	0.062	0.864	0.760-0.972	0.019*
T-RTS	X35	-0.724	0.174	0.485	0.351-0.696	<0.001*

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