手术干预延迟对儿科创伤结局的影响。

Impact of operative intervention delay on pediatric trauma outcomes.

机构信息

Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA, USA.

出版信息

J Trauma Acute Care Surg. 2012 Jul;73(1):162-7. doi: 10.1097/TA.0b013e31825699b4.

DOI:10.1097/TA.0b013e31825699b4

PMID:22743386

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4817716/

Abstract

BACKGROUND

Establishing quality indicators is an essential step in improving mortality and disability among pediatric patients with trauma. We hypothesized that timing of craniotomy, intracranial pressure (ICP) monitoring for traumatic brain injury, and abdominal operation for solid organ injury correlates with a reduced risk of death, shorter stay, and reduced risk of requiring assistance at discharge.

METHODS

This was a retrospective cohort study of 99,513 pediatric patients with trauma, using the National Trauma Data Bank.

RESULTS

For patients who had an ICP monitor placed within 4 hours compared with those whose ICP monitor was delayed, there was no difference in mortality; however, there was a shorter stay in the hospital (relative risk [RR], 0.84; 95% confidence interval (CI), 0.72-0.97) and in the intensive care unit (ICU) (RR, 0.76; 95% CI, 0.66-0.86) in those that survived to discharge. Patients who had craniotomy within 4 hours had higher mortality (RR, 1.98; 95% CI, 1.11-3.51) compared with those that were delayed. After excluding those that died, there was a shorter overall stay (RR, 0.69; 95% CI, 0.59-0.81) and ICU stay (RR, 0.69; 95% CI, 0.57-0.83). Similar length of stay results were seen in pediatric patients with solid organ injuries. Excluding those that died, length of stay (RR, 0.58; 95% CI, 0.47-0.73) and ICU stay (RR, 0.52; 95% CI, 0.37-0.74) were shorter.

CONCLUSION

Early intervention in those who survive their initial operation is associated with shorter ICU and hospital stay for traumatic brain and solid organ injuries.

LEVEL OF EVIDENCE

Therapeutic study, level III.

摘要

背景

建立质量指标对于改善创伤性儿科患者的死亡率和残疾率至关重要。我们假设开颅术的时机、创伤性脑损伤的颅内压（ICP）监测以及实体器官损伤的腹部手术与降低死亡率、缩短住院时间和降低出院时需要辅助的风险相关。

方法

这是一项使用国家创伤数据库的 99513 名创伤性儿科患者的回顾性队列研究。

结果

与 ICP 监测延迟的患者相比，在 4 小时内放置 ICP 监测器的患者死亡率没有差异；但是，存活至出院的患者住院时间（相对风险 [RR]，0.84；95%置信区间 [CI]，0.72-0.97）和重症监护病房（ICU）（RR，0.76；95% CI，0.66-0.86）更短。在 4 小时内进行开颅术的患者死亡率更高（RR，1.98；95% CI，1.11-3.51）与延迟的患者相比。排除死亡患者后，总住院时间（RR，0.69；95% CI，0.59-0.81）和 ICU 住院时间（RR，0.69；95% CI，0.57-0.83）更短。在患有实体器官损伤的儿科患者中也观察到了类似的住院时间结果。排除死亡患者后，住院时间（RR，0.58；95% CI，0.47-0.73）和 ICU 住院时间（RR，0.52；95% CI，0.37-0.74）更短。