Russell Robert T, Maizlin Ilan I, Vogel Adam M
Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama.
J Surg Res. 2017 Jun 15;214:216-220. doi: 10.1016/j.jss.2017.03.016. Epub 2017 Mar 31.
Viscoelastic monitoring (VEM), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in the setting of goal-directed hemostatic resuscitation has been shown to improve outcomes in adult trauma. The American College of Surgeons (ACS) Committee on Trauma recommends that "thromboelastography should be available at level I and level II trauma centers". The purpose of this study is to determine the current availability and utilization of VEM in pediatric trauma.
After IRB and Pediatric Trauma Society (PTS) approval, a survey was administered to the current members of the PTS via Survey Monkey. The survey collected demographic information, hospital and trauma program type, volume of trauma admissions, and use and/or availability of VEM for pediatric trauma patients.
We received 107 responses representing 77 unique hospitals. Survey respondents were: 61% physicians, 29% nurses, 6% trauma program managers, and 4% nurse practitioners/physician assistants. Over half of providers worked in a free standing children's hospital. Seventy-seven percent of respondents were from hospitals that had >200 trauma admissions/year, 42% were providers at ACS level 1 pediatric trauma centers, and 62% practiced at state level 1 designated centers. VEM was available to 63% of providers, but only 31% employed VEM in pediatric trauma patients. For those who had no VEM available, over 73% would utilize this technology if it was available. Seventy-one percent of providers continue to rely on conventional coagulation assays to monitor coagulopathy in pediatric trauma patients after admission.
While a growing body of evidence demonstrates the benefit of viscoelastic hemostatic assays in management of adult traumatic injuries, VEM during active resuscitation is infrequently used by pediatric trauma providers, even when the technology is readily available. This represents a timely and unique opportunity for quality improvement in pediatric trauma.
在目标导向性止血复苏中，黏弹性监测（VEM），包括血栓弹力图（TEG）和旋转血栓弹力测定法（ROTEM），已被证明可改善成人创伤患者的预后。美国外科医师学会（ACS）创伤委员会建议“一级和二级创伤中心应具备血栓弹力图检查设备”。本研究的目的是确定VEM在儿童创伤中的当前可用性和使用情况。
在获得机构审查委员会（IRB）和儿童创伤学会（PTS）批准后，通过Survey Monkey对PTS的现任成员进行了一项调查。该调查收集了人口统计学信息、医院和创伤项目类型、创伤入院量以及儿童创伤患者使用和/或可获得VEM的情况。
我们收到了107份回复，代表77家不同的医院。调查对象包括：61%为医生，29%为护士，6%为创伤项目管理人员，4%为执业护士/医师助理。超过一半的提供者在独立的儿童医院工作。77%的受访者来自每年有超过200例创伤入院的医院，42%是ACS一级儿童创伤中心的提供者，62%在州一级指定中心执业。63%的提供者可获得VEM，但只有31%在儿童创伤患者中使用VEM。对于那些无法获得VEM的人，如果有该技术，超过73%的人会使用。71%的提供者在儿童创伤患者入院后仍继续依靠传统凝血试验来监测凝血功能障碍。
虽然越来越多的证据表明黏弹性止血试验在成人创伤性损伤管理中的益处，但儿童创伤提供者在积极复苏期间很少使用VEM，即使该技术很容易获得。这为改善儿童创伤质量提供了一个及时且独特的机会。
