急诊创伤患者继发急性创伤性凝血功能障碍的影响因素分析及预测模型构建OA

Objective To investigate the influencing factors of secondary acute traumatic coagulopathy(ATC)in emergency trauma patients and to construct a predictive model,so as to provide a reference for identifying trauma patients at high risk of ATC and developing evidence-based interventions.Methods A total of 230 trauma patients admitted to the Emergency Department of The First Affiliated Hospital with Nanjing Medical University from January 2023 to December 2024 were se-lected.According to whether secondary ATC developed,patients were assigned to an ATC group(n=40)and a non-ATC group(n=190).After admission,clinical data including sex,age,past medical history,cause of injury,site of injury,in-jury severity,routine blood tests,coagulation parameters,and arterial blood gas indices at admission were collected.Univa-riate and multivariate logistic regression analyses were used to identify risk factors for secondary ATC in emergency trauma patients,and a nomogram prediction model was constructed using the R language based on the risk factors.The predictive performance of the nomogram model was evaluated using receiver operating characteristic(ROC)curves.Results Com-pared with the non-ATC group,the ATC group had older age,higher Injury Severity Score(ISS)at admission,higher pro-portion of patients with time to first blood transfusion>24 hours,higher proportion of patients receiving blood products,higher proportion of patients receiving vasoactive drugs,higher proportion of patients receiving mechanical ventilation,and higher levels of D-dimer and lactate;lower platelet count,lower albumin level,and lower fibrinogen level;and longer pro-thrombin time(PT),thrombin time(TT),and activated partial thromboplastin time(APTT),with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that decreased albumin level,decreased fibrinogen level,prolonged TT,elevated lactate level,and time to first blood transfusion>24 hours were risk factors for secondary ATC in emergency trauma patients(P<0.05).ROC curve analysis indicated that the area under the curve(AUC)of the nomogram prediction model for predicting secondary ATC in emergency trauma patients was 0.938(95%CI:0.885-0.991).Conclusion Albumin,fibrinogen,TT,and time to first blood transfusion are influencing factors for secondary ATC in emergency trauma patients.The constructed nomogram prediction model has good predictive performance for sec-ondary ATC in these patients.In clinical intervention,blood products should be administered to emergency trauma patients to reduce the risk of secondary ATC.