Bardes James M, Benjamin Elizabeth, Escalante Agustin Alvarez, Wu Jinglan, Demetriades Demetrios
Division of Trauma and Critical Care, University of Southern California Los Angeles, California, USA.
J Pediatr Surg. 2018 Aug;53(8):1523-1525. doi: 10.1016/j.jpedsurg.2017.09.017. Epub 2017 Oct 6.
Traumatic brain injury (TBI) is the leading cause of death among injured children. Depending on geographic location, and trauma resources, pediatric patients may be treated at pediatric (PTC), adult (ATC), or mixed trauma centers (MTC). The effect of the type of trauma center on outcomes in severe TBI is not known.
NTDB study (2007-2014), level 1 trauma centers, patients ≤14years with severe isolated TBI (head AIS≥3 and extracranial AIS≤2). Demographic, clinical and injury characteristics were abstracted. Logistic regression was used to compare outcomes between the three types of trauma centers.
10,402 patients met inclusion criteria. 4430 (42.6%) were admitted in PTC, 4044 (38.9%) in ATC and 1928 (18.5%) in MTC. Overall, 39.9% of patients had head AIS 3, 55.5% had AIS 4 and 4.6% AIS 5. Mortality was 3.2% (2.0% in PTC, 4.5% in ATC and 3.3% in MTC). On logistic regression, treatment at ATC was associated with significantly higher mortality than PTC (OR 1.55, p=0.011). There was no significant difference between PTC and MTC (p=0.394). There was no significant difference in mortality between the 3 types of trauma centers in the subgroups of patients with head AIS 3 or 5. However, patients with head AIS 4 treated at MTC had significantly lower mortality (OR 0.163, 95% CI 0.053-0.501, p=0.002).
Patients with isolated severe TBI treated at PTC have significantly better survival than patients treated at ATC, but not MTC. In the subgroup of patients with isolated TBI and a head AIS score of 4, patients treated at MTC have improved survival than those treated at PTC.
III.
创伤性脑损伤（TBI）是受伤儿童死亡的主要原因。根据地理位置和创伤资源的不同，儿科患者可能在儿科创伤中心（PTC）、成人创伤中心（ATC）或混合创伤中心（MTC）接受治疗。创伤中心类型对重度TBI患者预后的影响尚不清楚。
NTDB研究（2007 - 2014年），一级创伤中心，年龄≤14岁的重度单纯性TBI患者（头部简明损伤定级（AIS）≥3且颅外AIS≤2）。提取人口统计学、临床和损伤特征。采用逻辑回归比较三种类型创伤中心的预后。
10402例患者符合纳入标准。4430例（42.6%）入住PTC，4044例（38.9%）入住ATC，1928例（18.5%）入住MTC。总体而言，39.9%的患者头部AIS为3级，55.5%为4级，4.6%为5级。死亡率为3.2%（PTC为2.0%，ATC为4.5%，MTC为3.3%）。逻辑回归分析显示，在ATC接受治疗的患者死亡率显著高于PTC（比值比1.55，p = 0.011）。PTC和MTC之间无显著差异（p = 0.394）。在头部AIS为3级或5级的患者亚组中，三种类型创伤中心的死亡率无显著差异。然而，在MTC接受治疗的头部AIS为4级的患者死亡率显著较低（比值比0.163，95%置信区间0.053 - 0.501，p = 0.002）。
在PTC接受治疗的单纯性重度TBI患者的生存率显著高于在ATC接受治疗的患者，但与MTC相比无显著差异。在单纯性TBI且头部AIS评分为4级的患者亚组中，在MTC接受治疗的患者生存率高于在PTC接受治疗的患者。
III级。
