儿科和成人创伤中心在对严重受伤青少年的评估、治疗及结果方面存在差异。
Pediatric and adult trauma centers differ in evaluation, treatment, and outcomes for severely injured adolescents.
作者信息
Walther Ashley E, Falcone Richard A, Pritts Timothy A, Hanseman Dennis J, Robinson Bryce R H
机构信息
Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, USA.
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Department of Surgery, University of Cincinnati College of Medicine, USA.
出版信息
J Pediatr Surg. 2016 Aug;51(8):1346-50. doi: 10.1016/j.jpedsurg.2016.03.016. Epub 2016 Apr 12.
BACKGROUND/PURPOSE: This study aims to investigate differences in imaging, procedure utilization, and clinical outcomes of severely injured adolescents treated at adult versus pediatric trauma centers.
METHODS
The National Trauma Data Bank was queried retrospectively for adolescents, 15-19years old, with a length of stay (LOS) >1day and Injury Severity Score (ISS) >25 treated at adult (ATC) or pediatric (PTC) Level 1 trauma centers from 2007 to 2011. Patient demographics and utilization of imaging and procedures were analyzed. Univariate and multivariate regression analysis was used to compare outcomes.
RESULTS
Of 12,861 adolescents, 51% were treated at ATC. Older age and more nonwhites were seen at ATC (p<0.01). Imaging and invasive procedures were more common at ATC (p<0.01). Shorter LOS (p=0.03) and higher home discharge rates (p<0.01) were seen at PTC. ISS and mortality did not differ. Age, race, ATC care (all p<0.01), and admission systolic blood pressure (SBP) (p=0.03) were predictors of CT utilization. ISS, SBP, and race (p<0.01) were risk factors for overall mortality; SBP (p=0.03) and ISS (p<0.01) predicted death from penetrating injury.
CONCLUSIONS
Severely injured adolescents experience improved outcomes and decreased imaging and invasive procedures without additional mortality risk when treated at PTC. PTC is an appropriate destination for severely injured adolescents.
背景/目的：本研究旨在调查在成人创伤中心与儿科创伤中心接受治疗的重伤青少年在影像学检查、诊疗程序使用情况及临床结局方面的差异。
方法
对国家创伤数据库进行回顾性查询，纳入2007年至2011年期间在成人一级创伤中心（ATC）或儿科一级创伤中心（PTC）接受治疗、年龄在15至19岁、住院时间（LOS）>1天且损伤严重程度评分（ISS）>25的青少年。分析患者的人口统计学数据以及影像学检查和诊疗程序的使用情况。采用单因素和多因素回归分析比较结局。
结果
在12,861名青少年中，51%在ATC接受治疗。ATC的患者年龄较大且非白人更多（p<0.01）。ATC的影像学检查和侵入性操作更为常见（p<0.01）。PTC的住院时间较短（p=0.03）且出院回家率较高（p<0.01）。ISS和死亡率无差异。年龄、种族、ATC治疗（均p<0.01）以及入院收缩压（SBP）（p=0.03）是CT使用的预测因素。ISS、SBP和种族（p<0.01）是总体死亡率的危险因素；SBP（p=0.03）和ISS（p<0.01）可预测穿透伤导致的死亡。
结论
重伤青少年在PTC接受治疗时，结局得到改善，影像学检查和侵入性操作减少，且无额外的死亡风险。PTC是重伤青少年的合适治疗场所。
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