Magoteaux Summer R, Notrica David M, Langlais Crystal S, Linnaus Maria E, Raines Alexander R, Letton Robert W, Alder Adam C, Greenwell Cynthia, Eubanks James W, Lawson Karla A, Garcia Nilda M, St Peter Shawn D, Ostlie Daniel J, Leys Charles M, Bhatia Amina, Maxson R Todd, Tuggle David W, Ponsky Todd A
Maricopa Integrated Health System, Phoenix, AZ, United States.
Phoenix Children's Hospital, Phoenix, AZ, United States.
J Pediatr Surg. 2017 Jun;52(6):979-983. doi: 10.1016/j.jpedsurg.2017.03.021. Epub 2017 Mar 16.
Children with blunt liver or spleen injury (BLSI) requiring early transfusion may present without hypotension despite significant hypovolemia. This study sought to determine the relationship between early transfusion in pediatric BLSI and hypotension.
Secondary analysis of a 10-institution prospective observational study was performed of patients 18years and younger presenting with BLSI. Patients with central nervous system (CNS) injury were excluded. Children receiving blood transfusion within 4h of injury were evaluated. Time to first transfusion, vital signs, and physical exams were analyzed. Patients with hypotension were compared to those without hypotension.
Of 1008 patients with BLSI, 47 patients met inclusion criteria. 22 (47%) had documented hypotension. There was no statistical difference in median time to first transfusion for those with or without hypotension (2h vs. 2.5h, p=0.107). The hypotensive group was older (median 15.0 versus 9.5years; p=0.007). Median transfusion volume in the first 24h was 18.2mL/kg (IQR: 9.6, 25.7) for those with hypotension and 13.9mL/kg (IQR: 8.3, 21.0) for those without (p=0.220). Mortality was 14% (3/22) in children with hypotension and 0% (0/25) in children without hypotension.
Hypotension occurred in less than half of patients requiring early transfusion following pediatric BLSI suggesting that hypotension does not consistently predict the need for early transfusion.
Secondary analysis of a prospective observational study.
Level IV cohort study.
钝性肝或脾损伤（BLSI）的儿童即便存在严重低血容量，需要早期输血时也可能没有低血压表现。本研究旨在确定小儿BLSI早期输血与低血压之间的关系。
对一项10机构前瞻性观察性研究进行二次分析，研究对象为18岁及以下的BLSI患者。排除中枢神经系统（CNS）损伤的患者。对伤后4小时内接受输血的儿童进行评估。分析首次输血时间、生命体征和体格检查情况。将有低血压的患者与无低血压的患者进行比较。
1008例BLSI患者中，47例符合纳入标准。22例（47%）有记录的低血压。有或无低血压患者首次输血的中位时间无统计学差异（2小时对2.5小时，p = 0.107）。低血压组年龄较大（中位年龄15.0岁对9.5岁；p = 0.007）。有低血压的患者在最初24小时内的中位输血量为18.2mL/kg（四分位间距：9.6，25.7），无低血压的患者为13.9mL/kg（四分位间距：8.3，21.0）（p = 0.220）。低血压儿童的死亡率为14%（3/22），无低血压儿童的死亡率为0%（0/25）。
小儿BLSI后需要早期输血的患者中，不到一半发生低血压，这表明低血压并不能始终预测早期输血的需求。
前瞻性观察性研究的二次分析。
IV级队列研究。
