小儿创伤性肝损伤高干预风险患者。

Donnelly Katie A, Breslin Kristen, OʼConnell Karen J

From the Emergency Medicine and Trauma Center, Children's National Health System.

Pediatr Emerg Care. 2020 Jul;36(7):e373-e377. doi: 10.1097/PEC.0000000000001538.

OBJECTIVES

Nonoperative management of hemodynamically stable liver lacerations in pediatric trauma patients is a safe and effective management strategy for pediatric patients; approximately 90% will be successfully managed nonoperatively. No study has specifically identified risk criteria for the need for intervention versus observation alone. Our objective for this study was to determine risk factors from the physical examination, computed tomography scan, and laboratory results associated with intervention for liver laceration.

METHODS

We performed a retrospective cohort study using data from the Pediatric Emergency Care Applied Research Network Intra-abdominal Injuries Study public use data set. Data were collected prospectively at the time of enrollment; a limited data set was released for public use in 2014. Patients were included if they were diagnosed with a liver laceration by computed tomography scan. We used bivariable and multivariable analyses to determine associations of specific risk factors with intervention, defined as laparotomy, angiographic embolization, blood transfusion, death, or return to emergency department for any reason within 30 days.

RESULTS

Of the 12,044 patients in the Intra-abdominal Injuries Study, 282 were diagnosed with a liver laceration. All patients were hospitalized, and 99 (35.1%) underwent an intervention. Variables were then eliminated if more than 10% of cases were missing data. Multivariable logistic regression identified the following independent risk factors for intervention: white blood cell count greater than 15 K/mcl (adjusted odds ratio [adjOR], 2.83; 95% confidence interval [CI], 1.43-5.63), pelvic fracture (adjOR, 2.50; 95% CI, 1.02-6.10), liver injury greater than grade 2 (adjOR, 2.16; 95% CI, 1.06-4.40), Glasgow Coma Scale score less than 15 (adjOR, 4.77; 95% CI, 2.27-7.63), and hematocrit less than 32% (adjOR, 4.79; 95% CI, 2.00-11.46).

CONCLUSIONS

We identified 5 high-risk criteria associated with intervention for traumatic liver laceration in pediatric patients. Prospective studies are necessary to validate these results before using them to determine disposition of pediatric patients with traumatic liver injuries.

目的

对于儿科创伤患者中血流动力学稳定的肝裂伤，非手术治疗是一种安全有效的治疗策略；约90%的患者可通过非手术治疗成功处理。尚无研究专门确定需要干预而非仅观察的风险标准。本研究的目的是从体格检查、计算机断层扫描和实验室检查结果中确定与肝裂伤干预相关的危险因素。

方法

我们使用儿科急诊应用研究网络腹内损伤研究公共使用数据集的数据进行了一项回顾性队列研究。数据在入组时前瞻性收集；2014年发布了一个有限的数据集供公众使用。如果患者通过计算机断层扫描诊断为肝裂伤，则纳入研究。我们使用双变量和多变量分析来确定特定危险因素与干预的关联，干预定义为剖腹手术、血管造影栓塞、输血、死亡或在30天内因任何原因返回急诊科。

结果

在腹内损伤研究的12044例患者中，282例被诊断为肝裂伤。所有患者均住院治疗，99例（35.1%）接受了干预。如果超过10%的病例数据缺失，则剔除变量。多变量逻辑回归确定了以下干预的独立危险因素：白细胞计数大于15 K/mcl（调整优势比[adjOR]，2.83；95%置信区间[CI]，1.43 - 5.63）、骨盆骨折（adjOR，2.50；95% CI，1.02 - 6.10）、肝损伤大于2级（adjOR，2.16；95% CI，1.06 - 4.40）、格拉斯哥昏迷量表评分小于15（adjOR，4.77；95% CI，2.27 - 7.63）和血细胞比容小于32%（adjOR，4.79；95% CI，2.00 - 11.46）。