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损伤严重程度对小儿创伤住院患者静脉血栓栓塞症的发生率及利用相关结局的影响。

Effect of injury severity on the incidence and utilization-related outcomes of venous thromboembolism in pediatric trauma inpatients.

作者信息

Candrilli Sean D, Balkrishnan Rajesh, O'Brien Sarah H

机构信息

Department of Pharmacy Administration and Policy, The Ohio State University, College of Pharmacy, Columbus, OH, USA.

出版信息

Pediatr Crit Care Med. 2009 Sep;10(5):554-7. doi: 10.1097/PCC.0b013e3181a705d3.

Abstract

OBJECTIVE

The objective of this study was to generate national estimates of the effect of injury severity on the occurrence rate and associated resource utilization-related outcomes of venous thromboembolism (VTE) between pediatric and adolescent trauma inpatients in the United States.

DATA SOURCE

2003 Healthcare Cost and Utilization Project Kids' Inpatient Database, the largest all-payer pediatric (age < or =20 yrs) inpatient care database in the United States.

MEASUREMENTS AND MAIN RESULTS

VTE was identified in 2.7 per 1000 pediatric trauma discharges. Although injury severity is strongly associated with an increased risk of VTE, the occurrence rate is low even among critically injured patients (<2%). However, VTE has a significant and an independent impact on the length of stay and hospitalization costs in the critical care setting.

CONCLUSIONS

VTE increases both the length of stay and hospitalization costs independent of injury severity, demonstrating the need to consider thromboprophylaxis in the critically injured population. However, the low overall occurrence rate of VTE in young trauma patients, even in the intensive care unit, highlights the need for additional studies of risk factors and the potential risks of prophylactic anticoagulation, so that thromboprophylaxis can be more directly targeted to the children at highest risk.

摘要

目的

本研究的目的是对美国儿科和青少年创伤住院患者中,损伤严重程度对静脉血栓栓塞症(VTE)发生率及相关资源利用相关结局的影响进行全国性评估。

数据来源

2003年医疗保健成本与利用项目儿童住院数据库,美国最大的全付费儿科(年龄≤20岁)住院护理数据库。

测量指标与主要结果

每1000例儿科创伤出院病例中,VTE的发生率为2.7例。尽管损伤严重程度与VTE风险增加密切相关,但即使在重伤患者中,VTE的发生率也较低(<2%)。然而,VTE对重症监护环境下的住院时间和住院费用有显著且独立的影响。

结论

VTE会增加住院时间和住院费用,且与损伤严重程度无关,这表明有必要在重伤人群中考虑血栓预防措施。然而,年轻创伤患者中VTE的总体发生率较低,即使在重症监护病房也是如此,这凸显了对危险因素及预防性抗凝潜在风险进行更多研究的必要性,以便能更直接地针对高危儿童进行血栓预防。

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