小儿颈部穿透伤：损伤的硬性体征与选择性颈部探查
Pediatric penetrating neck trauma: Hard signs of injury and selective neck exploration.
作者信息
Tessler Rober A, Nguyen Huong, Newton Christoper, Betts James
机构信息
From the Department of Surgery (R.A.T.), UCSF East Bay; Division of Pediatric Surgery and Trauma Services (H.N.), UCSF Benioff Children's Hospital Oakland, Oakland, California; Trauma Division of Pediatric Surgery and Trauma Services (C.N.), and Surgery Division of Pediatric Surgery and Trauma Services (J.B.), UCSF Benioff Children's Hospital Oakland, Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2017 Jun;82(6):989-994. doi: 10.1097/TA.0000000000001407.
BACKGROUND
Selective neck exploration and computed tomography angiography (CTA) in penetrating neck trauma have been well described in adults. However, data in the pediatric population are sparse. The extent to which these practices have been adopted in pediatric patients is unknown.
METHODS
Retrospective, single-center cohort study of pediatric penetrating neck trauma for the years 2001 to 2014 in a dedicated children's hospital/Level 1 pediatric trauma center. Clinical data, sensitivity and specificity of hard signs (active hemorrhage, airway compromise, expanding hematoma, crepitus, and so on) and soft signs of injury (bruit, voice change, stridor, laceration less than 2 cm, nonexpanding hematoma, and so on), and trends in imaging were examined.
RESULTS
A total of 44 patients were identified with penetrating neck trauma. The majority of these patients were male (55%) aged 8 months to 18 years and a median of 7.3 years. Sixteen patients underwent neck exploration with 13 major injuries identified in 10 patients. Nineteen patients had associated injuries. Ten patients had at least one hard sign of injury, and 16 patients had only soft signs of injury. The sensitivity and specificity of hard signs of injury were 100% (95% confidence interval [CI], 59-100%) and 94.4% (95% CI, 79-99%), respectively. Soft signs only had a sensitivity and specificity of 100% (95% CI, 39-100%) and 75.5% (95% CI, 60-86%), respectively. Positive and negative predictive values were 4.8% and 100%, respectively, for both hard and soft signs. The number of CTA studies increased over time but was not statistically significant. Forty (90%) patients were discharged home and two patients died.
CONCLUSION
These results suggest that management of penetrating neck trauma in children includes selective neck exploration based on physical examination and the use of CTA in stable patients, similar to current adult recommendations. We did not observe evidence of missed injuries over the study period.
LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
背景
穿透性颈部创伤的选择性颈部探查和计算机断层血管造影（CTA）在成人中已有详尽描述。然而，儿科人群的数据却很稀少。这些方法在儿科患者中的应用程度尚不清楚。
方法
对2001年至2014年在一家专门的儿童医院/一级儿科创伤中心就诊的儿科穿透性颈部创伤患者进行回顾性单中心队列研究。研究了临床数据、硬体征（活动性出血、气道受压、血肿扩大、捻发音等）和软体征（杂音、声音改变、喘鸣、小于2厘米的裂伤、非扩展性血肿等）的敏感性和特异性，以及影像学检查的趋势。
结果
共确定44例穿透性颈部创伤患者。这些患者大多数为男性（55%），年龄在8个月至18岁之间，中位年龄为7.3岁。16例患者接受了颈部探查，10例患者发现了13处主要损伤。19例患者有合并伤。10例患者至少有一项硬体征损伤，16例患者仅有软体征损伤。损伤硬体征的敏感性和特异性分别为100%（95%置信区间[CI]，59 - 100%）和94.4%（95% CI，79 - 99%）。软体征的敏感性和特异性分别仅为100%（95% CI，39 - 100%）和75.5%（95% CI，60 - 86%）。硬体征和软体征的阳性预测值和阴性预测值分别为4.8%和100%。CTA检查的数量随时间增加，但无统计学意义。40例（90%）患者出院回家，2例患者死亡。
结论
这些结果表明，儿童穿透性颈部创伤的治疗包括根据体格检查进行选择性颈部探查，并对病情稳定的患者使用CTA，这与当前成人的建议相似。在研究期间，我们未观察到漏诊损伤的证据。
证据水平
治疗/护理管理，四级。
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