成人和儿科患者人群中穿透性胸部创伤的表现和结局与年龄相关的影响。
Age-associated impact on presentation and outcome for penetrating thoracic trauma in the adult and pediatric patient populations.
机构信息
From the Division of Cardiothoracic Surgery (N.M.M., T.K.V.), Department of Surgery, University of Washington, Seattle, Washington; Divisions of Pediatric (R.M.A.), General (D.T.), Trauma (G.J.M.), and Cardiothoracic (M.G.M.) Surgery, Department of Surgery, University of Illinois at Mount Sinai Hospital; and Department of Pharmacy Administration (F.-J. L.), University of Illinois at Chicago, Chicago, Illinois.
出版信息
J Trauma Acute Care Surg. 2014 Feb;76(2):273-7; discussion 277-8. doi: 10.1097/TA.0000000000000090.
BACKGROUND
Studies reporting on penetrating thoracic trauma in the pediatric population have been limited by small numbers and implied differences with the adult population. Our objectives were to report on a large cohort of pediatric patients presenting with penetrating thoracic trauma and to determine age-related impacts on management and outcome through comparison with an adult cohort.
METHODS
A Level I trauma center registry was queried between 2006 and 2012. All patients presenting with penetrating thoracic trauma were identified. Patient demographics, injury mechanism, injury severity, admission physiology, and outcome were recorded. Patients were compared, and outcomes were analyzed based on age at presentation, with patients 17 years or younger defining our pediatric cohort.
RESULTS
A total of 1,423 patients with penetrating thoracic trauma were admitted during the study period. Two hundred twenty patients (15.5%) were pediatric, with 205 being adolescents (13-17 years) and 15 being children (≤ 12 years). In terms of management for the pediatric population, tube thoracostomy alone was needed in 32.7% (72 of 220), whereas operative thoracic exploration was performed in 20.0% (44 of 220). Overall mortality was 13.6% (30 of 220). There was no significant difference between the pediatric and adult population with regard to injury mechanism or severity, need for therapeutic intervention, operative approach, use of emergency department thoracotomy, or outcome. Stepwise logistic regression failed to identify age as a predictor for the need for either therapeutic intervention or mortality between the two age groups as a whole. However, subgroup analysis revealed that being 12 years or younger (odds ratio, 3.84; 95% confidence interval, 1.29-11.4) was an independent predictor of mortality.
CONCLUSION
Management of traumatic penetrating thoracic injuries in terms of the need for therapeutic intervention and operative approach was similar between the adult and pediatric populations. Mortality from penetrating thoracic trauma can be predicted based on injury severity, the use of emergency department thoracotomy, and admission physiology for adolescents and adults. Children may be at increased risk for poor outcome independent of injury severity.
LEVEL OF EVIDENCE
Epidemiologic study, level III.
背景
报道小儿穿透性胸部创伤的研究受到数量有限的限制，并暗示与成人人群存在差异。我们的目的是报告大量出现穿透性胸部创伤的小儿患者，并通过与成人队列进行比较，确定与年龄相关的对治疗和结果的影响。
方法
在 2006 年至 2012 年期间，对一级创伤中心的登记处进行了查询。确定了所有出现穿透性胸部创伤的患者。记录患者的人口统计学，损伤机制，损伤严重程度，入院生理状况和结果。根据就诊年龄对患者进行比较，并根据年龄分析结果，将 17 岁或以下的患者定义为儿科队列。
结果
在研究期间，共有 1423 例穿透性胸部创伤患者入院。220 例（15.5％）为儿科患者，其中 205 例为青少年（13-17 岁），15 例为儿童（≤12 岁）。就小儿人群的管理而言，单纯的胸腔引流管在 32.7％（72/220）的患者中是必需的，而手术性胸腔探查在 20.0％（44/220）的患者中进行。总体死亡率为 13.6％（30/220）。在损伤机制或严重程度，治疗干预的必要性，手术方法，使用急诊室开胸术或结果方面，小儿和成人人群之间没有明显差异。逐步逻辑回归未能确定年龄是两个年龄组之间治疗干预或死亡率的预测因素。但是，亚组分析表明，年龄为 12 岁或以下（优势比，3.84；95％置信区间，1.29-11.4）是死亡的独立预测因子。
结论
在治疗干预和手术方法方面，成人和儿科人群的穿透性胸部创伤的治疗管理相似。青少年和成年人的创伤性穿透性胸部创伤的死亡率可以根据损伤严重程度，急诊室开胸术的使用和入院生理状况来预测。儿童可能由于受伤严重程度以外的原因而面临不良预后的风险增加。
证据水平
流行病学研究，三级。
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