Pflugeisen Bethann M, Escobar Mauricio A, Haferbecker Dustin, Duralde Yolanda, Pohlson Elizabeth
MultiCare Institute for Research & Innovation, Tacoma, Washington;
Department of Pediatric Surgery.
Hosp Pediatr. 2017 Apr;7(4):219-224. doi: 10.1542/hpeds.2016-0157. Epub 2017 Mar 21.
There has been an increasing movement worldwide to create systematic screening and management procedures for atypical injury patterns in children with the hope of better detecting and evaluating nonaccidental trauma (NAT). A legitimate concern for any hospital considering implementation of a systematic evaluation process is the impact on already burdened hospital resources. We hypothesized that implementation of a guideline that uses red flags related to history, physical, or radiologic findings to trigger a standardized NAT evaluation of patients <4 years would not negatively affect resource utilization at our level II pediatric trauma center.
NAT cases were evaluated retrospectively before and prospectively after implementation of the NAT guideline ( = 117 cases before implementation, = 72 cases postimplementation). Multiple linear and logistic regression, χ, and Wilcoxon rank-sum tests were used to evaluate human, laboratory, technology, and hospital resource usage between cohorts.
Human (child abuse intervention department, ophthalmology, and evaluation by a pediatric surgeon for admitted patients), laboratory (urine toxicology and liver function tests), and imaging (skeletal survey and head or abdominal computed tomography) resource use did not differ significantly between cohorts (all > .05). Emergency department and hospital lengths of stays also did not differ between cohorts. A significant 13% decrease in the percentage of patients admitted to the hospital was observed ( = .01).
Structured evaluation and management of pediatric patients with injuries atypical for their age does not confer an added burden on hospital resources and may reduce the percentage of such patients who are hospitalized.
全球范围内越来越多的行动旨在为儿童非典型损伤模式建立系统的筛查和管理程序，以期更好地检测和评估非意外创伤（NAT）。对于任何考虑实施系统评估流程的医院而言，一个合理的担忧是这对本就负担沉重的医院资源的影响。我们假设，实施一项利用与病史、体格检查或影像学检查结果相关的红旗指标来触发对4岁以下患者进行标准化NAT评估的指南，不会对我们的二级儿科创伤中心的资源利用产生负面影响。
在实施NAT指南之前对NAT病例进行回顾性评估，之后进行前瞻性评估（实施前117例，实施后72例）。使用多元线性和逻辑回归、χ²检验以及Wilcoxon秩和检验来评估两组之间人力、实验室、技术和医院资源的使用情况。
两组之间在人力（儿童虐待干预科室、眼科以及儿科外科医生对入院患者的评估）、实验室（尿液毒理学和肝功能检查）和影像学（骨骼检查以及头部或腹部计算机断层扫描）资源使用方面无显著差异（均P＞0.05）。两组之间急诊科留观时间和住院时间也无差异。观察到入院患者百分比显著下降了13%（P = 0.01）。
对年龄相关损伤不典型的儿科患者进行结构化评估和管理不会给医院资源带来额外负担，且可能降低此类患者的住院百分比。
