Rosenfeld Eric H, Lau Patricio, Shah Sohail R, Naik-Mathuria Bindi, Wesson David E, Wakeman Derek S, Vogel Adam M
Department of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
Department of Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY.
J Pediatr Surg. 2019 May;54(5):980-983. doi: 10.1016/j.jpedsurg.2019.01.031. Epub 2019 Jan 31.
The purpose of this study was to describe the epidemiology and evaluate the clinical significance of traumatic sternal fractures.
Patients age ≤18 years with sternal fractures in the National Trauma Database research datasets from 2007-2014 were identified. Patient demographics, injuries, procedures, and outcomes were analyzed using descriptive statistics and logistic regression.
Three thousand one hundred sixty patients with sternal fracture were identified. Ninety percent of injuries occurred in patients between 12 and 18 years old. Median injury severity score (ISS) was 17 [9,29]. Exploratory thoracotomy was performed in 1%. Thirty-nine percent were admitted to the intensive care unit (ICU). On multivariate regression, predictors of ICU stay >1 day were increasing ISS, lack of the use of protective devices, decreasing Glasgow Coma Score (GCS), tachycardia, and pulmonary contusion. Median hospital length of stay was 4 [2, 9] days. In-hospital mortality was 8%. Predictors of mortality were lower GCS, increasing ISS, decreasing oxygen saturation, hypotension, and cardiac arrest. Use of protective devices and seat belts did not affect mortality.
Sternal fractures in patients increase in incidence with age, and poor outcomes are impacted by associated injuries and complications. The presence of a sternal fracture should trigger a careful diagnostic evaluation.
III STUDY TYPE: Treatment Study.
本研究旨在描述创伤性胸骨骨折的流行病学特征，并评估其临床意义。
在2007 - 2014年国家创伤数据库研究数据集中，确定年龄≤18岁的胸骨骨折患者。使用描述性统计和逻辑回归分析患者的人口统计学特征、损伤情况、治疗措施及预后。
共确定3160例胸骨骨折患者。90%的损伤发生在12至18岁的患者中。损伤严重程度评分（ISS）中位数为17[9,29]。1%的患者接受了开胸探查术。39%的患者入住重症监护病房（ICU）。多因素回归分析显示，入住ICU超过1天的预测因素包括ISS升高、未使用防护装置、格拉斯哥昏迷评分（GCS）降低、心动过速和肺挫伤。住院时间中位数为4[2,9]天。院内死亡率为8%。死亡的预测因素包括GCS降低、ISS升高、血氧饱和度降低、低血压和心脏骤停。使用防护装置和安全带并不影响死亡率。
患者胸骨骨折的发病率随年龄增长而增加，不良预后受相关损伤和并发症的影响。胸骨骨折的存在应引发仔细的诊断评估。
III 研究类型：治疗研究。
