Department of Surgery, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
Division of Surgery, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
World J Emerg Surg. 2020 Sep 18;15(1):52. doi: 10.1186/s13017-020-00333-0.
The International Committee of the Red Cross (ICRC) implemented the Red Cross wound classification (RCWC) to quickly assess the severity of a wound in conflict settings. A subdivision into wound grades derived from the RCWC consists of grades 1, 2, and 3, and represents low, major, and massive energy transfer, respectively, to the injured tissue. The aim of this observational study is to assess whether the Red Cross wound grade of a pediatric patient's wound correlates with patient outcomes.
All pediatric patients (age < 15 years) treated in an ICRC hospital between 1988 and 2014 for conflict-related penetrating extremity injuries were retroactively included. Correlations were assessed between wound grades and number of surgeries, blood transfusions, days hospitalized, and mortality. Stratification analyses were performed to evaluate potential effect modifiers.
The study included 2463 pediatric patients. Pediatric patients with a higher wound grade received significantly more surgeries (grade 1 median 2; grade 3 median 3), more blood transfusions (grades 1 and 3 received 33.9 and 72.2 units per 100 patients, respectively), and were hospitalized longer (grade 1 median 15; grade 3 median 40 days). Mortality rates did not significantly differ. Stratification analyses did not reveal effect modifiers for the association between wound grades and patient outcomes.
The Red Cross wound grade of a pediatric patient's extremity wound correlates independently with treatment needs. This simple wound grading system could support clinical decision-making and should be integrated into the clinical assessment of weapon-wounded pediatric patients in conflict settings.
国际红十字委员会（ICRC）实施了红十字伤口分类（RCWC），以快速评估冲突环境中伤口的严重程度。RCWC 衍生的伤口分级细分为 1 级、2 级和 3 级，分别代表对受伤组织的低、大、大量能量转移。本观察性研究旨在评估小儿患者伤口的红十字伤口等级是否与患者结局相关。
回顾性纳入 1988 年至 2014 年间在 ICRC 医院因与冲突相关的穿透性四肢损伤接受治疗的所有小儿患者（年龄<15 岁）。评估了伤口等级与手术次数、输血、住院天数和死亡率之间的相关性。进行了分层分析以评估潜在的效应修饰剂。
研究纳入了 2463 名小儿患者。伤口等级较高的小儿患者接受的手术明显更多（1 级中位数 2 次；3 级中位数 3 次）、输血更多（1 级和 3 级分别接受了 33.9 和 72.2 单位/100 名患者），住院时间更长（1 级中位数 15 天；3 级中位数 40 天）。死亡率无显著差异。分层分析未发现伤口等级与患者结局之间关联的效应修饰剂。
小儿患者四肢伤口的红十字伤口等级与治疗需求独立相关。这种简单的伤口分级系统可以支持临床决策，应纳入冲突环境中武器致伤小儿患者的临床评估。
