Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Children's National Health System, Washington, District of Columbia.
J Surg Res. 2020 Feb;246:153-159. doi: 10.1016/j.jss.2019.08.008. Epub 2019 Oct 3.
Injured children who arrive by self-transport to the emergency department (ED) may receive delayed or inadequate care. We studied differences in demographics, clinical characteristics, and trauma activation status for admitted pediatric trauma patients based on arrival by self-transport or Emergency Medical Services (EMS).
We performed a retrospective cohort study at two level I pediatric trauma centers.
<15 y old with blunt or penetrating injury. We used univariate and multivariate logistic regression analyses to determine associations between trauma activation, ED length of stay (LOS), and hospital LOS with demographic and clinical characteristics.
We identified 1161 patients: 40.1% arrived by self-transport and 59.9% by EMS. Self-transport patients were less likely to have an abnormal Glasgow Coma Scale score < 15 (2.1% versus 22.0%, P < 0.001) and Injury Severity Score > 15 (2.4% versus 11.7%, P < 0.001). Trauma activation was initiated in 52.5% of patients, occurring less often in self-transport than EMS patients (2.4% versus 86.2%, P < 0.001). Trauma activation rate was negatively associated with arrival by self-transport (odds ratio [OR] 0.001, 95% CI 0.00-0.003), positively associated with Glasgow Coma Scale <15 (OR 25.9, 95% CI 6.6-101.2) and site (OR 15.4, 95% CI 6.3-37.5) but not with Injury Severity Score >15 (OR 2.8, 95% CI 0.8-9.2). Self-transport arrival was associated with longer ED LOS (estimated regression slope 0.47, 95% CI 0.13-0.82).
Almost half of admitted pediatric trauma patients arrived by self-transport; however, trauma team activation rarely occurs for these patients. Trauma team activation may be underutilized in self-transport patients with injuries resulting in hospital admission.
自行到急诊科（ED）就诊的受伤儿童可能会接受延迟或不充分的治疗。我们研究了根据自行转运或紧急医疗服务（EMS）到达的住院儿科创伤患者在人口统计学、临床特征和创伤激活状态方面的差异。
我们在两个一级儿科创伤中心进行了回顾性队列研究。
<15 岁，有钝器或穿透伤。我们使用单变量和多变量逻辑回归分析来确定创伤激活、ED 住院时间（LOS）和住院 LOS 与人口统计学和临床特征之间的关联。
我们共纳入 1161 例患者：40.1%自行转运，59.9%由 EMS 转运。自行转运的患者格拉斯哥昏迷评分<15（2.1% vs 22.0%，P<0.001）和损伤严重程度评分>15（2.4% vs 11.7%，P<0.001）的可能性较小。52.5%的患者启动了创伤激活，自行转运的患者比 EMS 转运的患者启动创伤激活的频率较低（2.4% vs 86.2%，P<0.001）。创伤激活率与自行转运呈负相关（比值比 [OR] 0.001，95%置信区间 0.00-0.003），与格拉斯哥昏迷评分<15（OR 25.9，95%置信区间 6.6-101.2）和部位（OR 15.4，95%置信区间 6.3-37.5）呈正相关，但与损伤严重程度评分>15（OR 2.8，95%置信区间 0.8-9.2）无关。自行转运到达与 ED LOS 延长有关（估计回归斜率 0.47，95%置信区间 0.13-0.82）。
近一半的住院儿科创伤患者自行到达；然而，这些患者很少启动创伤小组激活。对于因受伤而住院的自行转运患者，创伤小组的激活可能未得到充分利用。
