ABSTRACT
Objective:To investigate the value of serum C -reactive protein/prealbumin ratio (CRP/PA) in predicting the disease progression of adult patients with traumatic brain injury. Methods:A prospective study was conducted. Patients with traumatic brain injury who were over 18 years old and were followed up for more than 72 hours admitted to the department of emergency of Huashan North Hospital Affiliated to Fudan University from May 2018 to December 2019 were enrolled. The levels of serum CRP, PA were measured immediately after injury and at 6, 24, 48 and 72 hours after injury, and the CRP/PA ratio was calculated. Glasgow coma score (GCS) was dynamically measured and head CT was reviewed regularly. If the GCS decreased by more than 3 and/or the intracranial injury was aggravated by CT scan within 72 hours after injury, the patients were included in the aggravating group. If there were no above changes, they were included in the stable group. The differences of each index between the two groups were compared, and the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each index at different time points on the patient's disease progress.Results:A total of 106 patients were selected, including 89 patients in the stable group and 17 patients in the aggravating group, and the baseline data of the two groups were balanced. CRP, CRP/PA increased and PA decreased in brain trauma patients 6 hours after injury, and reached the peak value or valley value at 48 hours. Compared with the stable group, CRP/PA significantly increased at 24, 48 and 72 hours in the aggravating group [24 hours: 34.18 (20.19, 67.10) vs. 13.98 (4.36, 38.30), 48 hours: 71.10 (45.55, 96.97) vs. 16.02 (5.05, 41.76), 72 hours: 23.25 (4.46, 38.61) vs. 4.72 (2.38, 12.95), all P < 0.05]. ROC curve analysis showed that CRP/PA ratio at 24 hours and 48 hours after injury could be used as a predictor of disease progression. The area under the ROC curve (AUC) of 24 hours CRP/PA was 0.71, 95% confidence interval (95% CI) was 0.58-0.84, the cut -off value was 28.29, the sensitivity was 76.5%, and the specificity was 73.0%. The AUC of 48 hours CRP/PA was 0.76, 95% CI was 0.62-0.90, and the cut -off value was 37.18, the sensitivity was 88.2%, and the specificity was 70.8%. Conclusion:The dynamic monitoring of CRP/PA ratio in adult after traumatic brain injury can evaluate the disease condition, and the CRP/PA ratio of 24 hours and 48 hours can predict the progress of the disease.
ABSTRACT
Objective To establish a "patient-centered" integrated information platform for emergency interconnection. Methods Based on the existing software, hardware and network systems of the hospital, design ideas of the modularization, process and standardized were used to reshape the process of emergency diagnosis and treatment in department of emergency-critical care medicine of Huashan North Hospital,Fudan University, and develop integrated information platform for emergency interconnection, including triage, emergency physician workstation, electronic medical records, clinical pathways of key diseases, medical integration, electronic handover classes, imaging, testing, ultrasound, drug counseling and medication safety, performance appraisal and management systems of scientific research, etc. Results The information platform for emergency interconnection was successfully developed. The functional logic of each system was clear and concise. It had strong compatibility, stable performance and powerful processing capability. It could quickly query the target content and support free and fast switching of each window. At present, daily diagnosis and treatment of emergency patients were realized by informationization, which completely liberated the manual labor of medical staff, shortened the processing time of unit patient, and significantly improved efficiency of the work. At the peak of the patients' visit, the overall operation of the emergency department was stable, and all the work was carried out in an orderly manner. There was no delay of the diagnosis and treatment for critically ill patients in the emergency department. Emergency access to patients with key diseases was smooth, and waiting time was significantly shortened. Clinical decision-making of medical staff had been effectively regulated. The success rates of the patients with acute trauma or acute respiratory failure were significantly improved, the time of the critical treatment were significantly shortened in patients with emergency respiratory cardiac arrest or acute ST-segment elevation myocardial, and compliance rate of the door-to-balloon time met the requirements of the Emergency Room to Balloon Expansion Time (DTB) Alliance. Conclusion The integrated information platform for emergency interconnection ran through the whole process of emergency diagnosis and treatment, based on emergency clinical practice, which could meet the needs of daily work in emergency department and help improve the quality of emergency medical and department management.