Störmann Philipp, Weber Julia Nadine, Jakob Heike, Marzi Ingo, Schneidmueller Dorien
Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
Klinik für Chirurgie, Abteilung Unfall- und Wiederherstellungschirurgie, Kreiskrankenhaus St. Ingbert, Klaus-Tussing-Str. 1, St. Ingbert, 66386, Deutschland.
Unfallchirurg. 2018 Mar;121(3):223-229. doi: 10.1007/s00113-017-0312-7.
Severely injured children and adolescents in clinical practice are rare. For adequate treatment of these patients, detailed knowledge of anatomical and physiological peculiarities, as well as abundant injury patterns, are indispensable. Traumatic brain injuries are known to lead to an unfavorable outcome. In addition, thoracic trauma is regarded as prognostically unfavorable.
This study depicts epidemiology and injury patterns of severely injured children and adolescents focusing on peculiarities in the severely injured with associated thoracic injuries.
A retrospective analysis of underaged patients with suspicion of severe injuries who obtained emergency-room treatment in our level-one trauma center during a four-year time period was performed. The data was collected prospectively using the TraumaRegister® of the German Trauma Society as well as an extended house-internal dataset including data of daily clinical routine. The patients were divided into subgroups with (TT) and without (KT) thoracic trauma based on whether a thoracic injury was present or not. For further analysis, four age groups were established.
In all, 256 patients younger than 18 years were eligible. Of these, 46 patients revealed thoracic injuries. The mean age of patients with thoracic trauma (12.4 ± 4.9 years) was significantly higher than for patients without thoracic trauma (8.0 ± 5.2 years). In both subgroups, most patients were male (TT: 69.9%, KT: 64.8%). Patients with concomitant thoracic trauma showed a significantly higher injury severity score (ISS) than patients without thoracic trauma (ISS: TT: 26.7 ± 15.8 vs. KT: 8.1 ± 6.8 points). Mortality was higher for TT as well (TT: 6.9% vs. KT: 1.9%). For both groups, traffic accidents were the most common cause of injury. Of patients with thoracic injuries, 52.2% developed at least one complication during their hospital stay (KT: 12.9%).
Thoracic trauma is a relevant factor in children with regard to the severity of total injury and complications. Particular attention should therefore be paid to early diagnosis and treatment.
在临床实践中，严重受伤的儿童和青少年较为罕见。为了对这些患者进行充分治疗，详细了解其解剖学和生理学特点以及丰富的损伤模式是必不可少的。已知创伤性脑损伤会导致不良后果。此外，胸部创伤在预后方面也被认为不利。
本研究描述了严重受伤儿童和青少年的流行病学及损伤模式，重点关注伴有胸部损伤的严重受伤者的特点。
对在我们一级创伤中心接受急诊治疗的疑似严重受伤的未成年患者进行了为期四年的回顾性分析。数据通过德国创伤协会的TraumaRegister®前瞻性收集，以及一个扩展的医院内部数据集，包括日常临床常规数据。根据是否存在胸部损伤，将患者分为有胸部创伤（TT）和无胸部创伤（KT）的亚组。为了进一步分析，划分了四个年龄组。
共有256名18岁以下患者符合条件。其中，46名患者有胸部损伤。有胸部创伤患者的平均年龄（12.4±4.9岁）显著高于无胸部创伤患者（8.0±5.2岁）。在两个亚组中，大多数患者为男性（TT组：69.9%，KT组：64.8%）。伴有胸部创伤的患者的损伤严重程度评分（ISS）显著高于无胸部创伤的患者（ISS：TT组：26.7±15.8分，KT组：8.1±6.8分）。TT组的死亡率也更高（TT组：6.9%，KT组：1.9%）。对于两组，交通事故都是最常见的受伤原因。有胸部损伤的患者中，52.2%在住院期间至少出现一种并发症（KT组：12.9%）。
胸部创伤是影响儿童总体损伤严重程度和并发症的一个相关因素。因此，应特别关注早期诊断和治疗。
