1Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT. 2Division of Pediatric Surgery, Department of Surgery, University of Utah, Salt Lake City, UT.
Pediatr Crit Care Med. 2014 May;15(4):e183-91. doi: 10.1097/PCC.0000000000000102.
To compare PICU admission criteria following blunt traumatic liver laceration based on CT grade and/or physiologic instability with actual practice to improve efficiency of ICU admission.
Retrospective cohort study.
Patients with grade 3-6 liver lacerations, 2002-2010.
Hundred seventy-one infants and children, ages 1 month to 17 years.
None.
Preadmission signs of physiologic instability (i.e., coma and cardiac arrest), liver CT grading, and outcomes including length of stay and packed RBC transfusion after admission to ICU were collected. Multiple body region severe trauma was defined as more than or equal to 1 extra-abdominal body area abbreviated injury score more than or equal to 4. Actual ICU admissions were compared with predicted. Two patients died before ICU admission and five (3%) died afterward. Of 169 patients, 52 (31%) were initially admitted to the inpatient ward. Five percent received surgical care for liver injury. Twenty percent received packed RBCs emergently for shock, whereas 5% received their first packed RBCs after admission. Compared with ICU admissions, ward patients were significantly older, had lower Injury Severity Scores, and less operative care. Among ICU patients, transfusion for hemorrhagic shock was significantly associated with more severe injury scores. Sixty percent of ICU patients were not transfused. ICU triage determined by signs of physiologic instability predicted 53 admissions (31%) including seven of nine patients (78%) treated with transfusions after admission. Predicted ICU admission for nontransfused patients was lower-9%. Adding CT laceration grade more than or equal to 4 increased ICU admissions to 129 (76%). Among surviving ICU patients, 37 of 62 patients (60%) with isolated severe abdominal trauma and no systemic instability had ICU length of stay less than 1 day.
Children with isolated abdominal injury and no physiologic instability can generally be treated without ICU admission. Adding grade more than or equal to 4 to usual ICU admission criteria resulted in excessive admission of stable patients.
比较钝性肝外伤根据 CT 分级和/或生理不稳定的小儿重症监护病房（PICU）入院标准与实际实践，以提高 ICU 入院效率。
回顾性队列研究。
2002 年至 2010 年间，3-6 级肝裂伤患儿。
171 名年龄 1 个月至 17 岁的婴儿和儿童。
无。
收集入院前生理不稳定（即昏迷和心脏骤停）的迹象、肝 CT 分级以及包括 ICU 入院后住院时间和红细胞压积输注的结局。多处严重创伤定义为超过或等于 1 个腹部以外身体区域缩写损伤评分大于或等于 4。实际 ICU 入院与预测进行比较。2 例患者在 ICU 入院前死亡，5 例（3%）在入院后死亡。169 例患者中，52 例（31%）最初被收治在住院病房。5%的患者因肝损伤接受手术治疗。20%的患者因休克紧急接受红细胞压积输注，而 5%的患者在入院后首次接受红细胞压积输注。与 ICU 入院患者相比，病房患者年龄明显较大，损伤严重程度评分较低，手术治疗较少。在 ICU 患者中，出血性休克输血与更严重的损伤评分显著相关。60%的 ICU 患者未输血。由生理不稳定迹象确定的 ICU 分诊预测 53 例（31%）包括入院后接受输血的 9 例患者中的 7 例（78%）。预测未输血患者的 ICU 入院率较低为 9%。添加 CT 撕裂分级大于或等于 4 使 ICU 入院人数增加到 129 人（76%）。在幸存的 ICU 患者中，37 例孤立性严重腹部创伤且无全身不稳定的患者 ICU 住院时间小于 1 天。
孤立性腹部损伤且无生理不稳定的儿童通常可以不入院治疗。将大于或等于 4 级的分级添加到常规 ICU 入院标准中，导致稳定患者的过度入院。
