急性严重创伤患者自发性低体温风险预测模型的构建及验证

Construction and Validation of a Risk Prediction Model for Spontaneous Hypothermia in Patients with Acute Severe Trauma

摘要: 目的：分析急性严重创伤患者自发性低体温现状及危险因素，构建风险预测模型并探究应用效果。方法：采用便利抽样的方法，回顾性选取2022年12月~2023年12月来自江西省某三级甲等医院急诊创伤中心治疗的346例急诊创伤患者为研究对象，收集所有研究对象的一般临床资料及低体温的发生情况以及创伤的程度。根据患者体温值将研究对象分为低体温组(<36˚C)与非低体温组(≥36˚C)，比较两组患者一般临床资料的差异，利用Logistic回归方程构建风险预测模型并绘制ROC曲线图。结果：院前未输液、院内输液为加温、院内未使用保暖用具是严重创伤患者出现自发性低体温的独立危险因素。ROC曲线结果显示，自发性低体温风险预测模型的ROC曲线下面积为0.663 (95% CI: 0.958~0.992, P < 0.001)，灵敏度为92.8%，特异度为95.2%，预测准确率为92.3%。结论：院前未输液、院内输液未加温以及院内未使用保暖用具是严重创伤患者发生自发性低体温的独立危险因素，可为严重创伤患者自发性低体温的预防提供参考。

Abstract: Objective: To analyze the current status and risk factors of spontaneous hypothermia in patients with acute severe trauma, construct a risk prediction model, and explore its application effect. Method: Convenience sampling was used to select 346 emergency trauma patients treated at the Emergency Trauma Center of a tertiary hospital in Jiangxi Province from December 2022 to December 2023 as the research subjects. General clinical data and incidence of hypothermia were recorded for all study subjects, and ISS was used to evaluate the degree of trauma. According to the patient’s body temperature, the study subjects were divided into a hypothermia group (<36˚C) and a non hypothermia group (≥36˚C), and the differences in general clinical data between the two groups of patients were compared. A risk prediction model was constructed using logistic regression equation and an ROC curve was plotted. Results: No pre-hospital infusion, in-hospital infusion for warming, and no use of warming appliances in the hospital were independent risk factors for the development of spontaneous hypothermia in severely traumatised patients. The results of the ROC curves showed that the area under the ROC curve of the risk prediction model for spontaneous hypothermia was 0.663 (95% CI: 0.958~0.992, P < 0.001), with a sensitivity of 92.8%, a specificity of 95.2%, and a prediction accuracy of 92.3%. Conclusion: Failure to administer intravenous fluids before admission, failure to warm up intravenous fluids within the hospital, and failure to use warm equipment within the hospital are independent risk factors for spontaneous hypothermia in severely injured patients, which can provide reference for the prevention of spontaneous hypothermia in severely injured patients.