From the Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
Medical College of Wisconsin and Children's Hospital of Wisconsin, Wauwatosa, WI.
Pediatr Emerg Care. 2022 Jan 1;38(1):e193-e199. doi: 10.1097/PEC.0000000000002211.
The aim of this study was to investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs).
Retrospective chart review of children age 0 to 18 years who activated the trauma team response between January 1, 2015 and August 14, 2017, at a large, urban pediatric emergency department. The lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) were abstracted from the chart. χ2 and descriptive statistics were used for analysis.
The charts of 84 pediatric trauma patients were reviewed. Overall, 80% were boys with a mean age of 10.4 years (SD, 6.2 years). Injuries included 56% blunt trauma and 36% penetrating trauma with mortality of 10.7% (n = 9). Overall, the median lowest NIRS value was 67% (interquartile range, 51-80%; range, 15%-95%) and 54.8% of the patients had a NIRS value less than 70%. The median somatic NIRS duration recorded was 12 minutes (interquartile range, 6-17 minutes; range, 1-59 minutes). Overall, 50% of patients required a LSI, including 39 who required a lifesaving procedure, 11 required blood products, and 14 required vasopressors. Pediatric trauma patients with NIRS less than 70% had a significantly increased odds of requiring a LSI (odds ratio, 2.67; 95% confidence interval, 1.10-6.47). NIRS less than 70% had a sensitivity and specificity of 67% and 57% respectively.
Pediatric trauma patients with somatic NIRS less than 70% within 30 minutes of emergency department arrival are associated with the need for LSIs. Continuous NIRS monitoring in the pediatric trauma population should be evaluated prospectively.
本研究旨在探讨近红外光谱（NIRS）在识别需要救生干预（LSI）的儿科创伤患者中的作用。
回顾性分析 2015 年 1 月 1 日至 2017 年 8 月 14 日期间在一家大型城市儿科急诊科激活创伤团队反应的 0 至 18 岁儿童的病历。从病历中提取最低躯体 NIRS 饱和度和 LSI 的需求（基于已发表的共识定义）。采用 χ2 检验和描述性统计进行分析。
共回顾了 84 名儿科创伤患者的病历。总体而言，80%为男孩，平均年龄为 10.4 岁（标准差 6.2 岁）。损伤包括 56%的钝性创伤和 36%的穿透性创伤，死亡率为 10.7%（n=9）。总体而言，最低 NIRS 值中位数为 67%（四分位距 51-80%；范围 15%-95%），54.8%的患者 NIRS 值低于 70%。记录的最低躯体 NIRS 持续时间中位数为 12 分钟（四分位距 6-17 分钟；范围 1-59 分钟）。总体而言，50%的患者需要 LSI，包括 39 例需要救生程序，11 例需要血液制品，14 例需要血管加压素。NIRS 值低于 70%的儿科创伤患者需要 LSI 的可能性显著增加（优势比 2.67；95%置信区间 1.10-6.47）。NIRS 值低于 70%的敏感性和特异性分别为 67%和 57%。
急诊科到达后 30 分钟内 NIRS 值低于 70%的儿科创伤患者与需要 LSI 相关。应前瞻性评估儿科创伤人群中连续 NIRS 监测。
