在儿科创伤中心与成人创伤中心接受治疗的青少年钝性严重多发伤患者的结果差异。

Outcome differences in adolescent blunt severe polytrauma patients managed at pediatric versus adult trauma centers.

作者信息

Rogers Amelia T, Gross Brian W, Cook Alan D, Rinehart Cole D, Lynch Caitlin A, Bradburn Eric H, Heinle Colin C, Jammula Shreya, Rogers Frederick B

机构信息

From the Sidney Kimmel Medical College (A.T.R.), Thomas Jefferson University, Philadelphia, Pennsylvania; Trauma Services (B.W.G., C.D.R., C.A.L., E.H.B., C.C.H.), Lancaster General Health/Penn Medicine, Lancaster, Pennsylvania; and Trauma Research Program, Chandler Regional Medical Center, Chandler, Arizona.

出版信息

J Trauma Acute Care Surg. 2017 Dec;83(6):1082-1087. doi: 10.1097/TA.0000000000001642.

DOI:10.1097/TA.0000000000001642

PMID:28697019

Abstract

BACKGROUND

Previous research suggests adolescent trauma patients can be managed equally effectively at pediatric and adult trauma centers. We sought to determine whether this association would be upheld for adolescent severe polytrauma patients. We hypothesized that no difference in adjusted outcomes would be observed between pediatric trauma centers (PTCs) and adult trauma centers (ATCs) for this population.

METHODS

All severely injured adolescent (aged 12-17 years) polytrauma patients were extracted from the Pennsylvania Trauma Outcomes Study database from 2003 to 2015. Polytrauma was defined as an Abbreviated Injury Scale (AIS) score ≥3 for two or more AIS-defined body regions. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. ATC were defined as adult-only centers, whereas standalone pediatric hospitals and adult centers with pediatric affiliation were considered PTC. Multilevel mixed-effects logistic regression models assessed the adjusted impact of center type on mortality and total complications while controlling for age, shock index, Injury Severity Score, Glasgow Coma Scale motor score, trauma center level, case volume, and injury year. A generalized linear mixed model characterized functional status at discharge (FSD) while controlling for the same variables.

RESULTS

A total of 1,606 patients met inclusion criteria (PTC: 868 [54.1%]; ATC: 738 [45.9%]), 139 (8.66%) of which died in-hospital. No significant difference in mortality (adjusted odds ratio [AOR]: 1.10, 95% CI 0.54-2.24; p = 0.794; area under the receiver operating characteristic: 0.89) was observed between designations in adjusted analysis; however, FSD (AOR: 0.38, 95% CI 0.15-0.97; p = 0.043) was found to be lower and total complication trends higher (AOR: 1.78, 95% CI 0.98-3.32; p = 0.058) at PTC for adolescent polytrauma patients.

CONCLUSION

Contrary to existing literature on adolescent trauma patients, our results suggest patients aged 12-17 presenting with polytrauma may experience improved overall outcomes when managed at adult compared to pediatric trauma centers.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

摘要

背景

先前的研究表明，青少年创伤患者在儿科和成人创伤中心均可得到同样有效的治疗。我们试图确定这种关联在青少年严重多发伤患者中是否依然成立。我们假设，对于这一人群，儿科创伤中心（PTC）和成人创伤中心（ATC）在调整后的治疗结果上不会存在差异。

方法

从宾夕法尼亚创伤结局研究数据库中提取2003年至2015年期间所有严重受伤的青少年（12至17岁）多发伤患者。多发伤定义为两个或更多AIS定义的身体区域的简明损伤量表（AIS）评分≥3。排除入院时死亡、转院和穿透性创伤患者。ATC定义为仅收治成人的中心，而独立的儿科医院和有儿科附属机构的成人中心被视为PTC。多级混合效应逻辑回归模型评估中心类型对死亡率和总并发症的调整影响，同时控制年龄、休克指数、损伤严重程度评分、格拉斯哥昏迷量表运动评分、创伤中心级别、病例数量和受伤年份。广义线性混合模型在控制相同变量的情况下描述出院时的功能状态（FSD）。

结果

共有1606例患者符合纳入标准（PTC：868例[54.1%]；ATC：738例[45.9%]），其中139例（8.66%）在医院死亡。在调整分析中，不同类型中心之间未观察到死亡率有显著差异（调整后的优势比[AOR]：1.10，95%可信区间0.54 - 2.24；p = 0.794；受试者工作特征曲线下面积：0.89）；然而，发现青少年多发伤患者在PTC的FSD较低（AOR：0.38，95%可信区间0.15 - 0.97；p = 0.043），总并发症趋势较高（AOR：1.78，95%可信区间0.98 - 3.32；p = 0.058）。