U.S. Air Force En route Care Research Center 59th MDW/ST, Chief Scientist's Office-US Army Institute of Surgical research, San Antonio, TX.
Department of Emergency Medicine, San Antonio Military Medical Center, San Antonio, TX.
Pediatr Crit Care Med. 2020 Jul;21(7):e407-e413. doi: 10.1097/PCC.0000000000002317.
We aimed to describe and evaluate prehospital life-saving interventions performed in a pediatric population in the Afghanistan theater of operations.
Our study was a post hoc, subanalysis of a larger multicenter, prospective, observational study.
We evaluated casualties enrolled upon admission to one of the nine military medical facilities in Afghanistan between January 2009 and March 2014.
Adult and pediatric (<17 yr old) patients.
We conducted initial descriptive analyses followed by comparative tests. For comparative analysis, we stratified the study population (adult vs pediatric), and subsequently, we compared injury descriptions and the interventions performed. Following tests for normality, we used the t test or Wilcoxon rank-sum test (nonparametric) for continuous variables and chi-square or Fisher exact for categorical variables. We reported percentages and 95% CIs.
We enrolled 2,106 patients, of which 5.6% (n = 118) were pediatric. Eighty-two percent of the pediatric patients were male, and 435 had blast related injuries. A total of 295 prehospital life-saving interventions were performed on 118 pediatric patients, for an average of 2.5 life-saving interventions per patient. Vascular access (IV 96%, intraosseous 91%) and hypothermia prevention-related interventions (69%) were the most common. Incorrectly performed life-saving interventions in pediatric patients were rare (98% of life-saving interventions performed correctly) and n equals to 24 life-saving interventions over the 6-year period were missed. The most common incorrectly performed and missed life-saving interventions were related to vascular access. When compared with adult life-saving interventions received in the prehospital environment, pediatric patients were more likely to receive intraosseous access (p < 0.0001), whereas adult patients were more likely to have a tourniquet placed (p = 0.0019), receive wound packing with a hemostatic agent (p = 0.0091), and receive chest interventions (p = 0.0003).
In our study, the most common intervention was vascular access followed by hypothermia prevention and hemorrhage control. The occurrence of missed or incorrectly performed life-saving interventions were rare.
我们旨在描述并评估在阿富汗战区儿科人群中的院前救生干预措施。
我们的研究是一项事后、多中心前瞻性观察研究的子分析。
我们评估了 2009 年 1 月至 2014 年 3 月期间在阿富汗的 9 个军事医疗设施之一入院的伤员。
成人和儿科（<17 岁）患者。
我们进行了初步描述性分析，然后进行了比较性测试。对于比较分析，我们对研究人群（成人与儿科）进行了分层，然后比较了损伤描述和进行的干预措施。在进行正态性检验后，我们使用 t 检验或 Wilcoxon 秩和检验（非参数）比较连续变量，使用卡方检验或 Fisher 确切检验比较分类变量。我们报告了百分比和 95%置信区间。
我们共纳入 2106 名患者，其中 5.6%（n=118）为儿科患者。82%的儿科患者为男性，435 人有爆炸相关损伤。共有 295 名院前救生干预措施用于 118 名儿科患者，平均每名患者进行 2.5 次救生干预。血管通路（静脉 96%，骨髓内 91%）和预防低体温相关干预措施（69%）是最常见的干预措施。在儿科患者中，救生干预措施的执行错误很少见（98%的救生干预措施正确执行），并且在 6 年期间错过了 24 项救生干预措施。最常见的执行错误和错过的救生干预措施与血管通路有关。与院前环境下成人接受的救生干预措施相比，儿科患者更有可能接受骨髓内通路（p<0.0001），而成人患者更有可能使用止血带（p=0.0019）、接受带止血剂的伤口填塞（p=0.0091）和接受胸部干预（p=0.0003）。
在我们的研究中，最常见的干预措施是血管通路，其次是预防低体温和控制出血。救生干预措施的漏用或错误使用很少见。
