儿科复苏：基于体重的浓缩红细胞容量是死亡率的可靠预测指标。
Pediatric resuscitation: Weight-based packed red blood cell volume is a reliable predictor of mortality.
机构信息
From the Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery (K.N., M.H., K.T.A., M.Z., A.T., M.H., N.K., B.J.), College of Medicine, University of Arizona, Tucson, Arizona; and Department of Trauma Surgery (M.D.), Allegheny General Hospital, Pittsburgh, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2019 Aug;87(2):356-363. doi: 10.1097/TA.0000000000002305.
BACKGROUND
The definition of massive transfusion (MT) in civilian pediatric trauma patients is not established. In combat-injured pediatric patients, the definition of MT is based on the volume of total blood products transfused. The aim of this study is to define MT in civilian pediatric trauma patients based on a packed red blood cell (PRBC) volume threshold and compare its predictive power to a total blood products volume threshold.
METHODS
An analysis of the pediatric American College of Surgeons Trauma Quality Improvement Program database was performed (2014-2016) including pediatric trauma patients (4-18 years) who received blood products within 24 hours. Receiver operator characteristic curves for predicting mortality determined the optimal PRBC MT threshold. Area under receiver operating characteristic curve (AUROC) curve analysis was performed to compare the predictive power of a PRBC threshold to a total blood product threshold.
RESULTS
A total of 1,495 patients were included. Sensitivity and specificity for 24-hour and in-hospital mortality were optimal at a PRBC threshold of 20 mL/kg. As compared with total blood products threshold, 20 mL/kg PRBCs volume achieved higher discriminatory power for predicting 24-hour (AUROC, 0.803 vs. 0.672; p < 0.001) and in-hospital mortality (AUROC, 0.815 vs. 0.686, p < 0.001). Patients who received an MT had higher Injury Severity Score (p < 0.001) and were more likely to receive mechanical ventilation (p < 0.001) and intensive care unit admission (p < 0.001). Overall 24-hour mortality (23.1% vs. 7.6%, p < 0.001) and in-hospital mortality (44.9% vs. 15.8%, p < 0.001) were higher in the MT group. On regression analysis, MT significantly predicted in-hospital mortality (odds ratio, 3.8 [2.9-4.9, 95% CI]) and 24-hour mortality (odds ratio, 3.3 [2.4-4.7, 95% CI]).
CONCLUSION
The use of a PRBCs MT definition in civilian pediatric patients is a better predictor of mortality compared with total blood products threshold. These results provide a framework for MT protocol development.
LEVEL OF EVIDENCE
Prognostic study, level III.
背景
在民用儿科创伤患者中，大量输血（MT）的定义尚未确定。在战伤儿科患者中，MT 的定义基于输注的总血制品量。本研究的目的是基于红细胞压积（PRBC）体积阈值定义民用儿科创伤患者的 MT，并比较其对总血制品体积阈值的预测能力。
方法
对 2014-2016 年小儿外科学院创伤质量改进计划数据库中的儿科创伤患者（4-18 岁）进行分析，这些患者在 24 小时内接受了血液制品。接受者操作特征曲线（ROC）用于预测死亡率，以确定最佳 PRBC MT 阈值。进行 ROC 曲线分析以比较 PRBC 阈值与总血制品阈值的预测能力。
结果
共纳入 1495 例患者。PRBC 阈值为 20 mL/kg 时，24 小时和住院死亡率的敏感性和特异性最佳。与总血制品阈值相比，20 mL/kg PRBC 体积对预测 24 小时（AUROC，0.803 比 0.672；p < 0.001）和住院死亡率（AUROC，0.815 比 0.686，p < 0.001）具有更高的区分能力。接受 MT 的患者的损伤严重程度评分更高（p < 0.001），更有可能接受机械通气（p < 0.001）和 ICU 入住（p < 0.001）。MT 组的 24 小时总死亡率（23.1%比 7.6%，p < 0.001）和住院死亡率（44.9%比 15.8%，p < 0.001）更高。回归分析显示，MT 显著预测住院死亡率（优势比，3.8 [2.9-4.9，95%CI]）和 24 小时死亡率（优势比，3.3 [2.4-4.7，95%CI]）。
结论
与总血制品阈值相比，民用儿科患者中使用 PRBCs MT 定义是死亡率的更好预测指标。这些结果为 MT 方案的制定提供了框架。
证据水平
预后研究，III 级。
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