关键词: 急诊； 急危重多发伤； 胃肠破裂修复术； 不良预后； 风险预测模型

Abstract: Objective To construct and verify a risk prediction model for the poor prognosis after repair of traumatic perforation of gastrointestinal tract following emergency admission for acute and critical multiple injuries.Methods 183 patients with traumatic perforation of gastrointestinal tract due to acute and critical multiple injuries underwent treatment in emergency department of our hospital from January 2019 to December 2022 were enrolled.All were treated with symptomatic and reparative surgical protocols.Prognosis was recorded at 30d of the hospital follow-up,with death as the primary endpoint.Patient clinical data were collected.Logistic regression was used to screen the risk factors of poor prognosis,and a line graph model was established.Receiver Operating Curve (ROC) was used to test model differentiation.Calibration of models was evaluated with the Hosmer-Lemeshow goodness-of-fit test and calibration curve.Results After a follow-up of 30 days,28 cases died,and 38 cases had worsening clinical symptoms and signs compared to when they were admitted.The poor prognosis rate was 26.78%,and then divided into a poor prognosis group (49 cases) and a good prognosis group (134 cases).Multivariate Logistic regression analysis denoted that low GCS score,presence of shock,elevated D-dimer level,and high ISS score were risk factors affecting the poor prognosis after repair of traumatic perforation of gastrointestinal tract (P<0.05).The above risk factors were used to construct a line graph model for predicting the occurrence of poor prognosis after surgery,and the accuracy and differentiation of the model were verified showing an area under the curve of 0.986 and Hosmer-Lemeshow deviation test result of 0.984.Conclusion The low GCS score,presence of shock,elevated D-dimer level,and high ISS score are independent risk factors for poor prognosis after repair of traumatic perforation of gastrointestinal tract following emergency admission for acute and critical multiple injuries,and the predictive risk line graph model has high differentiation and precision,which is of great value for application in the prevention and treatment of traumatic perforation of gastrointestinal tract.

Key words: emergency treatment; acute and critical multiple injuries; repair of traumatic perforation of gastrointestinal tract; adverse prognosis; risk prediction model