From the Department of General Surgery (N.Y., D.S., K.S., E.C.-L.), Department of Pediatric Surgery (D.S., E.C.-L.), Yale University School of Medicine; and Department of General Surgery, Trauma and Surgical Critical Care (K.S.), New Haven, Connecticut.
J Trauma Acute Care Surg. 2020 Nov;89(5):894-899. doi: 10.1097/TA.0000000000002757.
Cross-sectional data of pediatric blunt solid organ injury demonstrates higher rates of nonoperative management and shorter lengths of stay (LOSs) in pediatric trauma centers (PTCs) versus adult trauma centers (ATCs) or dual trauma centers (DTCs). Recent iterations of guidelines (McVay 2008, J Pediatr Surg 2008;43(6):1072-1076 J Trauma Acute Care Surg 2015;79(4):683-693) have emphasized physiologic parameters rather than injury grade in clinical decision making, improving resource allocation and decreasing LOS. We sought to evaluate how these guidelines have influenced care.
The National Trauma Data Bank (2007-2016) was queried for isolated spleen and liver injuries in patients younger than 19 years. Linear regression, odds ratio (OR), and χ test were used to determine significance between operative intervention or LOS among different trauma center types and grade of injury.
A total of 55,036 blunt spleen or liver injuries were identified. Although operative rates decreased in ATCs over time (p = 0.037), patients treated at ATCs or DTCs continued to demonstrate higher ORs of operative intervention (OR, 4.43 and 2.88, respectively) compared with PTCs. Mean LOS decreased by 1.52 (p < 0.001), 0.49 (p = 0.26), and 1.31 (p = 0.05) days at ATC, DTC, and PTC to 6.43, 6.68, and 5.16 days. Improvement in LOS for ATCs was distributed across injury Grades I, II, and IV, while there was no correlation among PTCs for injury grade.
Despite more than a decade of guidelines in pediatric solid organ injury supporting nonoperative management and accelerated discharge pathways based on physiologic parameters, rates of operative intervention remain much higher in ATCs versus PTCs, and all centers appear to fall short of consensus guidelines for discharge.
Care management study, level IV.
儿科钝性实体器官损伤的横断面数据显示，与成人创伤中心（ATC）或双创伤中心（DTC）相比，儿科创伤中心（PTC）的非手术治疗率更高，住院时间（LOS）更短。最近的指南更新（McVay 2008，J Pediatr Surg 2008；43（6）：1072-1076 J Trauma Acute Care Surg 2015；79（4）：683-693）强调了生理参数在临床决策中的作用，而不是损伤程度，从而改善了资源配置并缩短了 LOS。我们试图评估这些指南是如何影响治疗的。
利用国家创伤数据库（2007-2016 年）查询年龄小于 19 岁的孤立性脾和肝损伤患者。线性回归、比值比（OR）和卡方检验用于确定不同创伤中心类型和损伤程度之间手术干预或 LOS 之间的显著性。
共确定了 55036 例钝性脾或肝损伤。尽管 ATC 中的手术率随时间呈下降趋势（p = 0.037），但与 PTC 相比，ATC 或 DTC 治疗的患者的手术干预 OR 仍更高（OR 分别为 4.43 和 2.88）。ATC、DTC 和 PTC 的 LOS 分别减少了 1.52（p < 0.001）、0.49（p = 0.26）和 1.31（p = 0.05）天，降至 6.43、6.68 和 5.16 天。ATC 中 LOS 的改善分布在损伤等级 I、II 和 IV 中，而 PTC 之间的损伤等级没有相关性。
尽管儿科实体器官损伤的指南已有十多年的历史，支持基于生理参数的非手术治疗和加速出院途径，但 ATC 中的手术干预率仍远高于 PTC，而且所有中心似乎都不符合共识指南的出院标准。
护理管理研究，IV 级。
