美国和意大利儿童医院急诊科轻微头部创伤管理的比较。
Comparison of minor head trauma management in the emergency departments of a United States and Italian Children's hospital.
机构信息
Computational Neuroscience Outcomes Center of Harvard, Brigham and Women's Hospital, Boston, MA, USA.
University of Trieste, Piazzale Europa, 1, 34127, Trieste, Italy.
出版信息
Ital J Pediatr. 2019 Feb 11;45(1):24. doi: 10.1186/s13052-019-0615-0.
BACKGROUND
Pediatric head trauma management varies between emergency departments globally. Here we aim to compare the pediatric minor head trauma management between a US and Italian hospital.
METHODS
We conducted a retrospective chart review of children 0-18 years old presenting after minor head trauma (Glasgow Coma Scale 14-15) from two emergency departments, in Boston, Massachusetts, United States and Trieste, Italy, between January and December 2013. Frequencies of demographic, clinical, and management characteristic were calculated. We compared rate ratios for characteristics of patients receiving cranial computed tomography (CT) scans between the two populations.
RESULTS
There were 1783 patients in Boston, Massachusetts and 183 patients in Trieste, Italy. Patients in Boston had more reported neurologic symptoms (61.2%) than in Trieste (6%) (p < 0.001). More CT scans were ordered on the patients in Boston (17.3% vs. 6.6%) (p < 0.001), while more children were hospitalized in Trieste (55.7% vs. 8.6%) (p < 0.001). Patients with neurological symptoms more commonly had a CT scan in Trieste (45.5%) than in Boston (23.5%) (RR 0.52, 95% CI 0.27, 1.00), while more patients without neurological symptoms had CTs in Boston (7.5%) than in Trieste (4.1%) (RR 1.85, 95% CI 0.86, 4.00). Assignment of triage levels and definitions of head injury severity varied considerably between the two hospitals, resulting in dissimilar populations presenting to the two hospitals, and thus, differences in the management of these children.
CONCLUSION
The population of head trauma patients and the management of pediatric minor head trauma differs between Boston and Trieste, with a preference for CT scans in Boston and a preference for hospitalization in Trieste. Clinical guidelines used at each institution likely lead to this variation in care influenced by the different patient populations and institutional resources.
背景
全球各急诊部门对小儿头部创伤的管理存在差异。在此，我们旨在比较美国和意大利一家医院之间小儿轻度头部创伤的管理。
方法
我们对 2013 年 1 月至 12 月期间美国马萨诸塞州波士顿和意大利的里雅斯特两家急诊部门因轻度头部创伤（格拉斯哥昏迷量表 14-15 分）就诊的 0-18 岁儿童进行了回顾性病历审查。计算了人口统计学、临床和管理特征的频率。我们比较了两组接受头颅计算机断层扫描（CT）的患者的特征率比值。
结果
马萨诸塞州波士顿有 1783 例患者，意大利的里雅斯特有 183 例患者。波士顿患者的神经症状（61.2%）比的里雅斯特（6%）多（p<0.001）。波士顿患者的 CT 扫描数量更多（17.3%比 6.6%）（p<0.001），而的里雅斯特患者的住院率更高（55.7%比 8.6%）（p<0.001）。有神经症状的患者在的里雅斯特更常见进行 CT 扫描（45.5%比波士顿 23.5%）（RR 0.52，95%CI 0.27, 1.00），而无神经症状的患者在波士顿更常见进行 CT 扫描（7.5%比的里雅斯特 4.1%）（RR 1.85，95%CI 0.86, 4.00）。两个医院的分诊级别和头部损伤严重程度的定义差异很大，导致两个医院的患者人群不同，因此，这些儿童的管理方式也不同。
结论
波士顿和的里雅斯特的头部创伤患者人群和小儿轻度头部创伤的管理方式存在差异，波士顿更倾向于 CT 扫描，而的里雅斯特更倾向于住院治疗。每个机构使用的临床指南可能导致这种护理差异，这受到不同患者人群和机构资源的影响。
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