Anders Jennifer F, Adelgais Kathleen, Hoyle John D, Olsen Cody, Jaffe David M, Leonard Julie C
The Department of Pediatrics, Johns Hopkins University, Baltimore, MD.
Acad Emerg Med. 2014 Jan;21(1):55-64. doi: 10.1111/acem.12288.
Pediatric cervical spine injury is rare. As a result, evidence-based guidance for prehospital triage of children with suspected cervical spine injuries is limited. The effects of transport time and secondary transfer for specialty care have not previously been examined in the subset of children with cervical spine injuries.
The primary objective was to determine if prehospital destination choice affects outcomes for children with cervical spine injuries. The secondary objectives were to describe prehospital and local hospital interventions for children ultimately transferred to pediatric trauma centers for definitive care of cervical spine injuries.
The authors searched the Pediatric Emergency Care Applied Research Network (PECARN) cervical spine injury data set for children transported by emergency medical services (EMS) from scene of injury. Neurologic outcomes in children with cervical spine injuries transported directly to pediatric trauma centers were compared with those transported to local hospitals and later transferred to pediatric trauma centers, adjusting for injury severity, indicated by altered mental status, focal neurologic deficits, and substantial comorbid injuries. In addition, transport times and interventions provided in the prehospital, local hospital, and pediatric trauma center settings were compared. Multiple imputation was used to handle missing data.
The PECARN cervical spine injury cohort contains 364 patients transported from scene of injury by EMS. A total of 321 met our inclusion criteria. Of these, 180 were transported directly to pediatric trauma centers, and 141 were transported to local hospitals and later transferred. After adjustments for injury severity, odds of a normal outcome versus death or persistent neurologic deficit were higher for patients transported directly to pediatric trauma centers (odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.03 to 3.47). EMS transport times to first hospital did not differ and did not affect outcomes. Prehospital analgesia was very infrequent.
Initial destination from scene (pediatric trauma center vs. local hospital) appears to be associated with neurologic outcome of children with cervical spine injuries. Markers of injury severity (altered mental status and focal neurologic findings) are important predictors of poor outcome in children with cervical spine injuries and should remain the primary guide for prehospital triage to designated trauma centers.
小儿颈椎损伤较为罕见。因此，针对疑似颈椎损伤儿童的院前分诊的循证指南有限。此前尚未在颈椎损伤儿童亚组中研究转运时间和专科护理二次转运的影响。
主要目的是确定院前目的地选择是否会影响颈椎损伤儿童的预后。次要目的是描述最终被转运至儿科创伤中心接受颈椎损伤确定性治疗的儿童的院前及当地医院干预措施。
作者在儿科急诊护理应用研究网络（PECARN）颈椎损伤数据集中搜索由紧急医疗服务（EMS）从受伤现场转运的儿童。将直接转运至儿科创伤中心的颈椎损伤儿童的神经学预后与转运至当地医院随后再转运至儿科创伤中心的儿童进行比较，并根据意识状态改变、局灶性神经功能缺损和严重合并伤所表明的损伤严重程度进行调整。此外，还比较了院前、当地医院及儿科创伤中心环境下的转运时间和所提供的干预措施。采用多重填补法处理缺失数据。
PECARN颈椎损伤队列包含364例由EMS从受伤现场转运的患者。共有321例符合我们的纳入标准。其中，180例直接转运至儿科创伤中心，141例转运至当地医院随后再转运。在对损伤严重程度进行调整后（意识状态改变、局灶性神经功能缺损和严重合并伤所表明的损伤严重程度），直接转运至儿科创伤中心的患者预后正常相对于死亡或持续性神经功能缺损的几率更高（优势比[OR]=1.89，95%置信区间[CI]=1.03至3.47）。EMS至第一家医院的转运时间无差异且不影响预后。院前镇痛非常少见。
受伤现场的初始目的地（儿科创伤中心与当地医院）似乎与颈椎损伤儿童的神经学预后相关。损伤严重程度指标（意识状态改变和局灶性神经学表现）是颈椎损伤儿童预后不良的重要预测因素，应仍然是院前分诊至指定创伤中心的主要指导依据。
