RISK FACTORS FOR DEATH IN PATIENTS WITH SEVERE TRAUMA AND THE PREDICTIVE VALUE OF JMHW SCORE FOR 28D MORTALITY

Lei Zhang, Yan Zhang, Mengjiao Song^*

Department of Critical Care Medicine, Dongying People Hospital, Dongying, PR China

Objective: To investigate the risk factors for death in patients with severe trauma, and the predictive value of the Japanese Ministry of Health and Welfare (JMHW) score for 28-day mortality. 

Methods: Data for a total of 568 patients with severe trauma admitted to the emergency surgery department of our hospital from September 2018 to September 2019 were collected. Factors that might lead to the death of patients were selected, and the risk factors for the death of patients with severe trauma were analysed by univariate and multivariate logistic regression analysis. All patients were evaluated by the JMHW rating, Korean Society of Thrombosis and Haemostasis (KSTH) and International Society on Thrombosis and Haemostasis score (ISTH) to analyse the predictive value of JMHW score for 28-day mortality in patients with severe trauma. 

Results: From September 2018 to September 2019, a total of 568 patients with severe trauma who met the inclusion criteria were admitted to our hospital. Of these 568 patients, 140 patients died, and the case fatality rate was 24.65%. There were 320 male patients, accounting for 56.34%. The most common types of injury were traffic injuries and blunt injuries. Univariate analysis showed that there was no statistically significant difference in the gender, trauma mechanism, injury, or treatment time between the two groups of patients (P>0.05). There were significant differences in age, ISS score, GCS score, and vital signs between the two groups of patients (P<0.05). Multivariate logistic regression analysis showed that age, hypotension at admission, an ISS score ≥16, and a GCS score were all influential factors for death in patients with severe trauma (P<0.05). The JMHW, KSTH, and ISTH scores in the survival group were significantly lower than those in the control group, and the differences were statistically significant (P<0.05). The ROC curve analysis showed that for the JMHW prediction for patients with severe trauma, the AUC was 0.862, the sensitivity was 89.23%, and the specificity was 85.02%; the KSTH predicted prognosis in severe trauma patients with an AUC of 0.795, a sensitivity of 81.26%, and a specificity of 83.25%; the AUC for predicting the prognosis of patients with severe trauma by ISTH was 0.746, the sensitivity was 76.50%, and the specificity was 77.22%. 

Conclusion: Patient age, hypotension at admission, ISS score, and GCS score are all risk factors for death in patients with severe trauma. JMHW, KSTH, and ISTH scores have some value in predicting the prognosis of patients. Among them, JMHW scores have the highest diagnostic value and can be widely used in clinical practice.