儿童颈部穿透伤：一项使用国家创伤数据库描述的罕见病症。
Penetrating neck trauma in children: An uncommon entity described using the National Trauma Data Bank.
作者信息
Stone Melvin Eugene, Farber Benjamin A, Olorunfemi Odunayo, Kalata Stanley, Meltzer James A, Chao Edward, Reddy Srinivas H, Teperman Sheldon
机构信息
From the Departments of Surgery (M.E.S., B.A.F., O.O., E.C., S.H.R., S.T.), and Pediatrics (J.A.M.), Jacobi Medical Center, Albert Einstein College of Medicine (S.K.), Bronx, New York.
出版信息
J Trauma Acute Care Surg. 2016 Apr;80(4):604-9. doi: 10.1097/TA.0000000000000976.
BACKGROUND
Penetrating neck trauma is uncommon in children; consequently, data describing epidemiology, injury pattern, and management are sparse. The aim of this study was to use the National Trauma Data Bank (NTDB) to describe pediatric penetrating neck trauma (PPNT).
METHODS
The NTDB was queried for children (defined as <15 years old) with PPNT between years 2008 and 2012. Descriptive analysis was used to describe age groups (0-5, 6-10, and 11-14 years) and injury type categorized as aerodigestive, vascular, cervical spine, and nerve.
RESULTS
A total of 1,238 patients with penetrating neck trauma were identified among 434,788 children in the NTDB (0.28%). Mean age was 7.9 years, and 70.6% of patients were male. The most common mechanisms of injury were stabbing (44%) and gunshot/firearm (24%). Most patients were treated at a pediatric trauma center (65.8%). Computed tomographic scan was the most frequent (42.2%) diagnostic study performed, followed by laryngoscopy (27.0%) and esophagoscopy (27.4%). Almost a quarter of patients (23.7%) went directly to the operating room from the emergency department (ED). Aerodigestive injuries were most common and occurred more frequently in the youngest age group (p < 0.001). Operative procedures for aerodigestive type injuries were most common (82.7%). There were 69 deaths, yielding a mortality rate of 5.6%. When adjusting for age, admission to a pediatric trauma center, and injury type, only vascular injury (odds ratio, 3.92; 95% confidence interval, 2.19-7.24; p < 0.0001) and ED hypotension (odds ratio, 27.12; 95% confidence interval, 15.11-48.67; p < 0.0001) were found to be independently associated with death.
CONCLUSION
PPNT is extremely rare--0.28% reported NTDB incidence. Age seems to influence injury type but does not affect mortality. Computed tomographic scan is the dominant diagnostic study used for selective management. Vascular injury type and hypotension on presentation to the ED were independently associated with mortality.
LEVEL OF EVIDENCE
Prognostic/epidemiologic study, level III.
背景
儿童穿透性颈部创伤并不常见；因此，关于其流行病学、损伤模式及治疗的数据较为匮乏。本研究旨在利用国家创伤数据库（NTDB）描述儿童穿透性颈部创伤（PPNT）。
方法
查询NTDB中2008年至2012年间患有PPNT的儿童（定义为年龄小于15岁）。采用描述性分析来描述年龄组（0 - 5岁、6 - 10岁和11 - 14岁）以及损伤类型，损伤类型分为气道消化道、血管、颈椎和神经损伤。
结果
在NTDB的434,788名儿童中，共识别出1238例穿透性颈部创伤患者（0.28%）。平均年龄为7.9岁，70.6%的患者为男性。最常见的致伤机制是刺伤（44%）和枪击/火器伤（24%）。大多数患者在儿科创伤中心接受治疗（65.8%）。计算机断层扫描是最常进行的诊断检查（42.2%），其次是喉镜检查（27.0%）和食管镜检查（27.4%）。近四分之一的患者（23.7%）从急诊科（ED）直接进入手术室。气道消化道损伤最为常见，且在最年幼的年龄组中发生率更高（p < 0.001）。气道消化道型损伤的手术操作最为常见（82.7%）。共有69例死亡，死亡率为5.6%。在对年龄、入住儿科创伤中心情况及损伤类型进行调整后，仅血管损伤（比值比，3.92；95%置信区间，2.19 - 7.24；p < 0.0001）和急诊科低血压（比值比，27.12；95%置信区间，15.11 - 48.67；p < 0.0001）被发现与死亡独立相关。
结论
PPNT极为罕见——NTDB报告的发病率为0.28%。年龄似乎影响损伤类型，但不影响死亡率。计算机断层扫描是用于选择性治疗的主要诊断检查。血管损伤类型和就诊时的低血压与死亡率独立相关。
证据水平
预后/流行病学研究，III级。
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