Livingston J K, Grigorian A, Kuza C M, Lekawa M, Bernal N, Allen A, Nahmias J
Department of Surgery, University of California Irvine, 101 The City Dr S, Orange, CA, 92868, USA.
Department of Anesthesiology, Keck School of Medicine of the University of Southern California, 1450 San Pablo Street, Suite 3600, Los Angeles, CA, 90033, USA.
Pediatr Surg Int. 2019 Jul;35(7):779-784. doi: 10.1007/s00383-019-04482-5. Epub 2019 May 10.
More than half a million children experience non-accidental trauma (NAT) annually. Historically, NAT has been associated with an increased hospital length of stay (LOS). We hypothesized that in pediatric trauma patients, NAT is associated with longer hospital LOS, independent of injury severity, compared to accidental trauma (AT).
The Pediatric Trauma Quality Improvement Program (2014-2016) was queried for patients aged 1-16 years. Patients were stratified into two groups: AT and NAT. The median LOS for the entire cohort was identified and used in a multivariable logistic regression analysis.
From 93,089 pediatric trauma patients, 417 (< 0.1%) were involved in NAT. Patients with NAT had a lower median age (3 vs. 9 years, p < 0.001) and higher median injury severity score (10 vs. 5, p < 0.001), compared to patients with AT. After controlling for covariates, patients with NAT were associated with a longer hospital LOS (≥ 2 days), compared to those with AT (OR = 4.99 CI = 3.55-7.01, p < 0.001). In comparison to AT, NAT was also associated with a higher mortality rate (10.3% vs. 0.8%, p < 0.001).
Pediatric patients presenting after NAT have a prolonged hospital and ICU LOS, even after adjusting for injury severity. Furthermore, pediatric victims of NAT had a higher mortality rate compared to those presenting after AT.
每年有超过50万儿童遭受非意外创伤（NAT）。从历史上看，NAT与住院时间延长（LOS）有关。我们假设，在儿科创伤患者中，与意外创伤（AT）相比，NAT与更长的住院LOS相关，且与损伤严重程度无关。
查询儿科创伤质量改进项目（2014 - 2016年）中1 - 16岁的患者。患者被分为两组：AT和NAT。确定整个队列的中位LOS，并用于多变量逻辑回归分析。
在93,089名儿科创伤患者中，417名（<0.1%）涉及NAT。与AT患者相比，NAT患者的中位年龄较低（3岁对9岁，p<0.001），中位损伤严重程度评分较高（10对5，p<0.001）。在控制协变量后，与AT患者相比，NAT患者的住院LOS更长（≥2天）（OR = 4.99，CI = 3.55 - 7.01，p<0.001）。与AT相比，NAT的死亡率也更高（10.3%对0.8%，p<0.001）。
即使在调整损伤严重程度后，NAT后就诊的儿科患者的住院和ICU LOS仍会延长。此外，与AT后就诊的患者相比，NAT的儿科受害者死亡率更高。
