成人 1 级创伤中心救治儿童创伤的效果：是否有专门护理的附加益处？

Treatment outcomes of injured children at adult level 1 trauma centers: are there benefits from added specialized care?

机构信息

Department of Surgery, Howard University College of Medicine, Washington, DC, USA.

出版信息

Am J Surg. 2011 Apr;201(4):445-9. doi: 10.1016/j.amjsurg.2010.10.006.

DOI:10.1016/j.amjsurg.2010.10.006

PMID:21421097

Abstract

BACKGROUND

Accidental traumatic injury is the leading cause of morbidity and mortality in children. The authors hypothesized that no mortality difference should exist between children seen at ATC (adult trauma centers) versus ATC with added qualifications in pediatrics (ATC-AQ).

METHODS

The National Trauma Data Bank, version 7.1, was analyzed for patients aged <18 years seen at level 1 trauma centers. Bivariate analysis compared patients by ATC versus ATC-AQ using demographic and injury characteristics. Multivariate analysis adjusting for injury and demographic factors was then performed.

RESULTS

A total sample of 53,702 children was analyzed, with an overall mortality of 3.9%. The adjusted odds of mortality was 20% lower for children seen at ATC-AQ (odds ratio, .80; 95% confidence interval, .68-.94). Children aged 3 to 12 years, those with injury severity scores > 25, and those with Glasgow Coma Scale scores < 8 all had significant reductions in the odds of death at ATC-AQ.

CONCLUSIONS

Improved overall survival is associated with pediatric trauma patients treated at ATC-AQ.

摘要

背景

意外伤害是导致儿童发病率和死亡率的主要原因。作者假设，在成人创伤中心（ATC）和具有儿科专业资质的 ATC（ATC-AQ）就诊的儿童之间，死亡率不应存在差异。

方法

对国家创伤数据库版本 7.1 中在 1 级创伤中心就诊的年龄<18 岁的患者进行了分析。使用人口统计学和损伤特征对 ATC 与 ATC-AQ 患者进行了双变量分析。然后，根据损伤和人口统计学因素进行了多变量分析。

结果

对 53702 名儿童进行了总体分析，总体死亡率为 3.9%。在 ATC-AQ 就诊的儿童死亡的调整比值比（OR）低 20%（OR，0.80；95%置信区间，0.68-0.94）。年龄在 3 至 12 岁、损伤严重程度评分>25 分和格拉斯哥昏迷评分<8 分的儿童，在 ATC-AQ 就诊时死亡的可能性均显著降低。