Notrica David M, Sayrs Lois W, Krishna Nidhi, Ostlie Daniel J, Letton Robert W, Alder Adam C, St Peter Shawn D, Ponsky Todd A, Eubanks James W, Tuggle David W, Garcia Nilda M, Leys Charles M, Maxson R Todd, Bhatia Amina M
Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016.
Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ, USA 85016.
J Pediatr Surg. 2019 Feb;54(2):335-339. doi: 10.1016/j.jpedsurg.2018.08.061. Epub 2018 Sep 17.
After NOM for BLSI, APSA guidelines recommend activity restriction for grade of injury +2 in weeks. This study evaluates activity restriction adherence and 60 day outcomes.
Non-parametric tests and logistic regression were utilized to assess difference between adherent and non-adherent patients from a 3-year prospective study of NOM for BLSI (≤18 years).
Of 1007 children with BLSI, 366 patients (44.1%) met the inclusion criteria of a completed 60 day follow-up; 170 (46.4%) had liver injury, 159 (43.4%) had spleen injury and 37 (10.1%) had both. Adherence to recommended activity restriction was claimed by 279 (76.3%) patients; 49 (13.4%) reported non-adherence and 38 (10.4%) patients had unknown adherence. For 279 patients who adhered to activity restrictions, unplanned return to the emergency department (ED) was noted for 35 (12.5%) with 16 (5.7%) readmitted; 202 (72.4%) returned to normal activity by 60 days. No patient bled after discharge. There was no statistical difference between adherent patients (n = 279) and non-adherent (n = 49) for return to ED (χ2 = 0.8 [p < 0.4]) or readmission (χ2 = 3.0 [p < 0.09]); for 216 high injury grade patients, there was no difference between adherent (n = 164) and non-adherent (n = 30) patients for return to ED (χ2 = 0.6 [p < 0.4]) or readmission (χ2 = 1.7 [p < 0.2]).
For children with BLSI, there was no difference in frequencies of bleeding or ED re-evaluation between patients adherent or non-adherent to the APSA activity restriction guideline.
Level II, Prognosis.
对于小儿钝性肝脏脾脏损伤（BLSI）采用非手术治疗（NOM）后，美国儿科学会外科协会（APSA）指南建议根据损伤分级在数周内限制活动。本研究评估了活动限制的依从性及60天的预后情况。
采用非参数检验和逻辑回归分析，对一项为期3年的小儿钝性肝脏脾脏损伤（≤18岁）非手术治疗的前瞻性研究中依从和不依从的患者进行差异评估。
在1007例小儿钝性肝脏脾脏损伤患者中，366例（44.1%）符合纳入标准并完成了60天的随访；其中170例（46.4%）有肝脏损伤，159例（43.4%）有脾脏损伤，37例（10.1%）两者均有。279例（76.3%）患者声称遵守了建议的活动限制；49例（13.4%）报告未遵守，38例（10.4%）患者的依从情况未知。在279例遵守活动限制的患者中，35例（12.5%）因未计划的情况返回急诊科（ED），其中16例（5.7%）再次入院；202例（72.4%）在60天时恢复正常活动。出院后无患者出血。在返回急诊科（χ2 = 0.8 [p < 0.4]）或再次入院（χ2 = 3.0 [p < 0.09]）方面，依从的患者（n = 279）和不依从的患者（n = 49）之间无统计学差异；对于216例高损伤分级的患者，在返回急诊科（χ2 = 0.6 [p < 0.4]）或再次入院（χ2 = 1.7 [p < 0.2]）方面，依从的患者（n = 164）和不依从的患者（n = 30）之间也无差异。
对于小儿钝性肝脏脾脏损伤患者，遵守或不遵守APSA活动限制指南的患者在出血频率或急诊科重新评估方面无差异。
二级，预后。
