儿童钝性腹部创伤后孤立性低级别实体器官损伤：是否到了考虑从急诊科出院的时间？
Isolated low-grade solid organ injuries in children following blunt abdominal trauma: Is it time to consider discharge from the emergency department?
机构信息
From the Department of Surgery (L.P., D.V., J.Z., C.J.S.), Division of Pediatric Surgery, Medical University of South Carolina, Charleston, South Carolina; Division of Pediatric Surgery (R.W.), Le Bonheur Children's Hospital, Children's Foundation Research Institute, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Pediatric Surgery (A.J.), University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California; and Division of Pediatric Surgery, Department of Surgery (B.N.-M., L.E.), Baylor College of Medicine, Houston, Texas.
出版信息
J Trauma Acute Care Surg. 2020 Nov;89(5):887-893. doi: 10.1097/TA.0000000000002899.
INTRODUCTION
Acute intervention (AI) for solid organ injury (SOI) is rare in hemodynamically stable children. Pediatric guidelines recommend admission with follow-up laboratories, even for low-grade injuries.
METHODS
Data sets from two large multicenter prospective observational studies were used to analyze a cohort of children (age, <17 years) with grade I to III SOI following blunt abdominal trauma. Children with hollow viscus injuries were excluded. Patients were divided into (a) those with or without other major injuries (OMIs) (traumatic brain injury, hemothorax or pneumothorax, pelvic fracture, urgent orthopedic or neurosurgical operations) and (b) with grade I or II versus grade III injuries. Outcomes included AIs (transfusion, angiography, abdominal operation) and disposition (admission unit and length of stay).
RESULTS
There were 14,232 children enrolled in the two studies, and 791 patients had a SOI (5.6%). After excluding patients with hollow viscus injuries and higher-grade SOIs, 517 patients with a grade I to III SOI were included, and 262 of these had no OMI. Among patients with no OMI, none of 148 patients with grade I or II SOI underwent AI, while only 3 of 114 patients with grade III injuries underwent AI (3 transfusions/1 angioembolization). All three had hemoperitoneum; two of three had an additional organ with a grade II injury. Among grade I and II SOIs with no OMI, 28 (18.9%) of 148 were admitted to an intensive care unit, 110 (74.3%) of 148 to floor, and 7 (4.7%) of 148 discharged home from emergency department; median length of stay 2 days. Among grade III SOIs with no OMI, 38 (33.3%) of 114 were admitted to an intensive care unit and 61.4% to the floor; median length of stay was 4 days. Among 255 patients with a grade I to III SOI and other major organ system injuries, 31 (12.2%) underwent AI.
CONCLUSION
No patient with a grade I and II SOI and no OMI following blunt abdominal trauma received intervention, suggesting that patients with low-grade SOI without OMIs could be safely observed and discharged from the emergency department.
LEVEL OF EVIDENCE
Therapeutic study, level IV.
简介
在血流动力学稳定的儿童中，实体器官损伤（SOI）的急性干预（AI）很少见。儿科指南建议即使是低级别损伤也要住院并进行后续实验室检查。
方法
使用来自两个大型多中心前瞻性观察性研究的数据集，分析了一组因钝性腹部创伤而导致 I 至 III 级 SOI 的儿童（年龄<17 岁）。排除了有中空脏器损伤的患者。将患者分为（a）有无其他主要损伤（OMI）的患者（颅脑损伤、血胸或气胸、骨盆骨折、紧急骨科或神经外科手术）和（b）I 级或 II 级与 III 级损伤的患者。结果包括 AI（输血、血管造影、腹部手术）和处理方式（入院科室和住院时间）。
结果
两项研究共纳入了 14232 名儿童，其中 791 名患者有 SOI（5.6%）。排除有中空脏器损伤和更高级别 SOI 的患者后，纳入了 517 名 I 至 III 级 SOI 患者，其中 262 名患者无 OMI。在无 OMI 的患者中，I 级或 II 级 SOI 患者中无 148 名患者接受 AI，而 III 级损伤的 114 名患者中仅有 3 名接受 AI（3 例输血/1 例血管栓塞）。所有 3 例均有腹腔积血，其中 2 例还合并其他器官的 II 级损伤。在无 OMI 的 I 级和 II 级 SOI 中，28 例（18.9%）148 例患者入住重症监护病房，110 例（74.3%）148 例患者入住普通病房，7 例（4.7%）148 例患者从急诊室出院；中位住院时间为 2 天。在无 OMI 的 III 级 SOI 中，114 例患者中 38 例（33.3%）入住重症监护病房，61.4%入住普通病房；中位住院时间为 4 天。在 255 名 I 至 III 级 SOI 合并其他主要器官系统损伤的患者中，31 名（12.2%）接受了 AI。
结论
在钝性腹部创伤后，无 OMI 的 I 级和 II 级 SOI 患者无一例接受 AI，这表明无 OMI 的低级别 SOI 患者可安全观察并从急诊科出院。
证据水平
治疗研究，IV 级。
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