Gutman Ilya M, Niemeier Thomas E, Gilbert Shawn R
Children's of Alabama, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
J Pediatr Orthop. 2019 Sep;39(8):e636-e640. doi: 10.1097/BPO.0000000000001204.
Large national databases have been increasingly used in recent years to determine the rate of adverse events and identify factors associated with altered surgical outcomes. This can be especially useful to evaluate rare events such as 30-day mortality. Despite differences between national pediatric databases, there have been no comparison studies in the pediatric orthopaedic population.
The Healthcare Cost and Utilization Project's Kids' Inpatient Database (KID) along with the American College of Surgeons National Surgical Quality Improvement Program Pediatric (NSQIP Pediatric) databases were queried to identify common pediatric orthopaedic procedures for humeral fractures, scoliosis, slipped capital femoral epiphysis, and femoral fractures during a single year. Clinical characteristics and complications in the 2 databases were compared using Student t test, χ, or Fisher' exact test.
In total, 26,978 patients in the KID and 5186 patients in the NSQIP Pediatric databases were identified. Large differences were observed between the databases in identical procedure categories with respect to age, race, sex, and length of stay. Regardless of procedure, NSQIP Pediatric had statistically higher reported rates of cumulative complications. Surgical site infections and sepsis were consistently observed to be at least twice as common in the NSQIP Pediatric database in comparison to the KID. Overall, complication rates ranged from <1% in humeral fractures to >100% in neuromuscular scoliosis.
Clinically and statistically significant differences exist between the KID and NSQIP Pediatric databases. Clinicians and researchers who utilize large databases must understand the differences in data import, quality control, and population sampling in order to provide adequate representation of the population as a whole.
Level III, prognostic study.
近年来，大型国家数据库越来越多地用于确定不良事件发生率，并识别与手术结果改变相关的因素。这对于评估罕见事件（如30天死亡率）尤其有用。尽管国家儿科数据库之间存在差异，但尚未有针对儿科骨科人群的比较研究。
查询医疗保健成本和利用项目的儿童住院数据库（KID）以及美国外科医师学会国家外科质量改进计划儿科数据库（NSQIP儿科），以确定某一年中肱骨骨折、脊柱侧弯、股骨头骨骺滑脱和股骨骨折等常见儿科骨科手术。使用Student t检验、χ²检验或Fisher精确检验比较两个数据库中的临床特征和并发症。
KID数据库中共识别出26978例患者，NSQIP儿科数据库中共识别出5186例患者。在相同手术类别中，两个数据库在年龄、种族、性别和住院时间方面存在很大差异。无论手术方式如何，NSQIP儿科报告的累积并发症发生率在统计学上更高。与KID相比，NSQIP儿科数据库中手术部位感染和败血症的发生率始终至少高出一倍。总体而言，并发症发生率从肱骨骨折的<1%到神经肌肉性脊柱侧弯的>100%不等。
KID和NSQIP儿科数据库在临床和统计学上存在显著差异。使用大型数据库的临床医生和研究人员必须了解数据导入、质量控制和人群抽样方面的差异，以便充分代表整个群体。
三级，预后研究。
