Sanchez J L, Lucas J, Feustel P J
Department of Pediatrics, Albany Medical College, Albany, NY 12208, USA.
J Trauma. 2001 Sep;51(3):478-80. doi: 10.1097/00005373-200109000-00009.
Institutional protocol designates the adult trauma service as the primary manager of all adolescent traumas (age 14-18 years) unless admission to the pediatric intensive care unit (PICU) occurs. In the PICU, primary care becomes the responsibility of the pediatric intensivist, with trauma service as a consultant. The purpose of this study was to identify differences in the management of adolescent trauma between the pediatric intensivist in the PICU, and the adult trauma team in the surgical intensive care unit (SICU).
From January 1993 to January 1998, the medical records of all adolescent trauma patients requiring intensive care unit (ICU) management were reviewed. Depending on bed availability, patients younger than 16 were admitted to the PICU, and those 16 or older to the SICU. Demographic data obtained were age, sex, race, mechanism of injury, length of stay (LOS), ICU length of stay, days on mechanical ventilation, intubation, tracheotomy, intracranial pressure monitor, and Swan-Ganz catheter placement. Home discharge, rehabilitation placement, and death were recorded. Morbidity was measured using Injury Severity Score methodology, Pediatric Trauma Score, and Pediatric Risk of Mortality.
One hundred nine completed records were reviewed (SICU, n = 58; PICU, n = 51). There was no statistical difference in sex, race, mechanism of injury, ICU LOS, tracheotomy, and intracranial pressure monitor placements. There was no difference in morbidity, as measured by Injury Severity Score, Pediatric Trauma Score, and Pediatric Risk of Mortality score or in outcome measurements (death, rehabilitation placement). SICU patients were older (SICU, 16.9 +/- 1.0 years; PICU, 15.4 +/- 1.0 years; p < or = 0.1 Mann-Whitney U test), more likely to be intubated (SICU, n = 42; PICU, n = 24; p < or = 0.05 Fisher's exact test), more likely to have pulmonary artery catheter placement (SICU, n = 7; PICU, n = 0), and had longer LOS (SICU, 12.2 +/- 10.6; PICU, 9.8 +/- 14.1; p < or = 0.03 Mann-Whitney U test).
Adolescent trauma patients admitted to the PICU were less likely to be intubated or have a Swan-Ganz catheter placed. They had decreased LOS and days of mechanical ventilation. There was no difference in outcome measurements.
机构协议规定，除非青少年创伤患者（14 - 18岁）需入住儿科重症监护病房（PICU），否则成人创伤服务团队将作为所有此类创伤患者的主要管理团队。在PICU中，主要护理工作由儿科重症监护医师负责，创伤服务团队则作为顾问。本研究的目的是确定PICU中的儿科重症监护医师与外科重症监护病房（SICU）中的成人创伤团队在青少年创伤管理方面的差异。
回顾1993年1月至1998年1月期间所有需要重症监护病房（ICU）管理的青少年创伤患者的病历。根据床位情况，16岁以下患者入住PICU，16岁及以上患者入住SICU。获取的人口统计学数据包括年龄、性别、种族、损伤机制、住院时间（LOS）、ICU住院时间、机械通气天数、插管、气管切开、颅内压监测以及放置Swan - Ganz导管情况。记录患者出院回家、康复安置及死亡情况。使用损伤严重程度评分方法、儿科创伤评分和儿科死亡风险评估发病率。
共审查了109份完整病历（SICU组58份；PICU组51份）。在性别、种族、损伤机制、ICU住院时间、气管切开及颅内压监测放置方面无统计学差异。在通过损伤严重程度评分、儿科创伤评分和儿科死亡风险评分衡量的发病率或结局指标（死亡、康复安置）方面也无差异。SICU患者年龄更大（SICU组，16.9±1.0岁；PICU组，15.4±1.0岁；p≤0.1，曼 - 惠特尼U检验），更有可能接受插管（SICU组42例；PICU组24例；p≤0.05，费舍尔精确检验），更有可能放置肺动脉导管（SICU组7例；PICU组0例），且住院时间更长（SICU组，12.2±10.6天；PICU组，9.8±14.1天；p≤0.03，曼 - 惠特尼U检验）。
入住PICU的青少年创伤患者接受插管或放置Swan - Ganz导管的可能性较小。他们的住院时间和机械通气天数减少。结局指标方面无差异。
