肺栓塞：哪些儿科创伤患者有风险？

Pulmonary embolism: which pediatric trauma patients are at risk?

作者信息

Truitt Anne K, Sorrells Donald L, Halvorson Eric, Starring Jayne, Kurkchubasche Arlet G, Tracy Thomas F, Luks Francois I

机构信息

Division of Pediatric Surgery, Brown Medical School and Hasbro Children's Hospital, Providence, RI 02905, USA.

出版信息

J Pediatr Surg. 2005 Jan;40(1):124-7. doi: 10.1016/j.jpedsurg.2004.09.017.

DOI:10.1016/j.jpedsurg.2004.09.017

PMID:15868571

Abstract

BACKGROUND/PURPOSE: Deep vein thrombosis and pulmonary embolism (DVT/PE) are rare in pediatric trauma patients, and guidelines for prophylaxis are scarce. The authors sought to identify subgroups of patients who may be at higher risk of developing DVT/PE.

METHODS

Case-control study of pediatric trauma patients with DVT/PE. Odds ratios (ORs) and confidence intervals (CIs) were calculated for known risk factors of PE using matched trauma controls (chi2 analysis).

RESULTS

A total of 3637 pediatric trauma patients was admitted over the last 7 years. Three patients developed DVT/PE (overall incidence, 0.08%). There were 2 girls and 1 boy, aged 15, 15, and 9 years, respectively. All 3 had an Injury Severity Score (ISS) > or =25 and an initial Glasgow Coma Score (GCS) < or =8. None of the known and potential risk factors significantly increased the OR for developing DVT/PE: age 9 years or older (OR, 3.6; CI, 0.4-26), presence of head injury (OR, 2.9; CI, 0.3-22), female sex (OR, 1.2; CI, 0.15-9.1), GCS < or =8 (OR, 9.2; CI, 0.9-230), except ISS > or =25 (OR, 82; CI, 7.6-2058). The OR for a combination of age and GCS was 106, and the OR for the 3 risk factors (age, ISS, GCS) common to all 3 patients was 114 (CI, 10-5000; P < .001).

CONCLUSIONS

The overall incidence of DVT/PE in pediatric trauma patients is <0.1% and routine prophylaxis is not recommended. Children aged 9 years or older with an initial GCS < or =8 and patients with an estimated ISS > or =25 may constitute a high-risk group in which prophylaxis could be considered.

摘要

背景/目的：小儿创伤患者发生深静脉血栓形成和肺栓塞（DVT/PE）的情况较为罕见，且预防指南也很匮乏。作者试图确定可能发生DVT/PE风险较高的患者亚组。

方法

对患有DVT/PE的小儿创伤患者进行病例对照研究。使用匹配的创伤对照（卡方分析）计算PE已知危险因素的比值比（OR）和置信区间（CI）。

结果

在过去7年中，共收治了3637例小儿创伤患者。3例患者发生了DVT/PE（总发生率为0.08%）。有2名女孩和1名男孩，年龄分别为15岁、15岁和9岁。所有3例患者的损伤严重程度评分（ISS）≥25，初始格拉斯哥昏迷评分（GCS）≤8。已知的和潜在的危险因素均未显著增加发生DVT/PE的OR：年龄9岁及以上（OR，3.6；CI，0.4 - 26）、存在头部损伤（OR，2.9；CI，0.3 - 22）、女性（OR，1.2；CI，0.15 - 9.1）、GCS≤8（OR，9.2；CI，0.9 - 230），但ISS≥25除外（OR，82；CI，7.6 - 2058）。年龄和GCS联合的OR为106，所有3例患者共有的3个危险因素（年龄、ISS、GCS）的OR为114（CI，10 - 5000；P <.001）。