Drucker Natalie A, McDuffie Lucas, Groh Eric, Hackworth Jodi, Bell Teresa M, Markel Troy A
Indiana University School of Medicine, Section of Pediatric Surgery, Indianapolis, Indiana.
Riley Hospital for Children, Indiana University Health, Section of Pediatric Surgery, Indianapolis, Indiana.
J Emerg Med. 2018 Jan;54(1):1-7. doi: 10.1016/j.jemermed.2017.08.008. Epub 2017 Nov 6.
Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting.
The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC.
Data from 2010-2014 at an American College of Surgeons-certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p < 0.05 was considered statistically significant.
Eight hundred sixty-two patients 0-18 years of age presented to the hospital after an MVC during the study period. Seventeen patients (2.0%) required abdominal exploration and all were found to have intraabdominal injuries. Respiratory rate was the only vital sign that was significantly altered (p = 0.04) in those who required abdominal surgery compared with those who did not. Physical examination findings, such as the seat belt sign, abdominal bruising, abdominal wound, and abdominal tenderness, were present significantly more frequently in those requiring abdominal surgery (p < 0.0001). Each finding had a negative predictive value for the need for operative exploration of at least 0.98. There were no significant differences in trauma laboratory values or radiographic findings between the 2 groups.
Data from this study solidify the relationship between specific physical examination findings and the need for abdominal exploration after MVC in children. In addition, these data suggest that a lack of the seat belt sign, abdominal bruising, abdominal wounds, or abdominal tenderness are individually predictive of patients who will not require surgical intervention.
机动车碰撞（MVC）后对儿童进行剖腹探查术很少见。在影像学检查未发现明确出血或腹腔游离气体的情况下，手术探查的预测指标存在争议。
本研究的目的是探索有助于确定哪些儿童在MVC后需要进行腹部手术探查的客观发现。
回顾性分析了2010年至2014年在美国外科医师学会认证的一级儿科创伤中心的数据。分析了人口统计学、生命体征、实验室数据、影像学研究、手术记录、相关损伤和结局，p<0.05被认为具有统计学意义。
在研究期间，862名0至18岁的患者在MVC后入院。17名患者（2.0%）需要进行腹部探查，所有患者均发现有腹腔内损伤。与不需要腹部手术的患者相比，呼吸频率是唯一在需要腹部手术的患者中显著改变的生命体征（p=0.04）。体格检查发现，如安全带征、腹部瘀伤、腹部伤口和腹部压痛，在需要腹部手术的患者中出现的频率明显更高（p<0.0001）。每项发现对手术探查需求的阴性预测值至少为0.98。两组之间的创伤实验室值或影像学发现没有显著差异。
本研究的数据巩固了特定体格检查发现与儿童MVC后腹部探查需求之间的关系。此外，这些数据表明，没有安全带征、腹部瘀伤、腹部伤口或腹部压痛可分别预测不需要手术干预的患者。
