创伤性脑损伤患儿转至美国外科医师学会一级儿科创伤中心后的质量指标。
Quality Indicators for Children With Traumatic Brain Injury After Transition to an American College of Surgeons Level I Pediatric Trauma Center.
机构信息
From the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL.
Children's Minnesota Research Institute.
出版信息
Pediatr Emerg Care. 2022 Jan 1;38(1):e329-e336. doi: 10.1097/PEC.0000000000002276.
OBJECTIVE
The aim of the study was to compare quality indicators, including frequency of acute surgical and emergent interventions, and resource utilization before and after American College of Surgeons (ACS) level I trauma verification among children with moderate or severe traumatic brain injury (TBI).
METHODS
This is a retrospective review of patients younger than 18 years treated for moderate or severe TBI, as determined by International Classification of Disease codes. Our institution obtained ACS level I trauma verification in 2013. Outcomes during the pre-ACS (June 2003-May 2008), interim (June 2008-May 2013), and post-ACS (June 2013-May 2018) periods were compared via nonparametric tests. Tests for linear trend were conducted using Cochran-Armitage tests for categorical data and by linear regression for continuous variables.
RESULTS
There were 677 children with moderate or severe TBIs (pre-ACS, 125; interim, 198; post-ACS, 354). Frequency of any surgical intervention increased significantly in the post-ACS period (12.2%) compared with interim (5.1%) and pre-ACS periods (5.6%, P = 0.007). More children in the post-ACS period required intracranial pressure monitoring (P = 0.017), external ventricular drain placement (P = 0.003), or endotracheal intubation (P = 0.001) compared with interim and pre-ACS periods. There was no significant change in time to operating room (P = 0.514), frequency of decompression (P = 0.096), or time to decompression (P = 0.788) between study periods. The median time to head CT decreased significantly in the post-ACS period (26 minutes; interquartile range [IQR], 9-60) compared with interim (36 minutes; IQR, 21-69) and pre-ACS periods (53 minutes; IQR, 36-89; P < 0.001). Frequency of repeat head computed tomography decreased significantly in the post-ACS period (30.2%) compared with interim (56.1%) and pre-ACS periods (64.0%, Ptrend = 0.044).
CONCLUSIONS
Transition to an ACS level I trauma verification was associated with improvements in quality indicators for children with moderate or severe TBI.
目的
本研究旨在比较美国外科医师学院（ACS）一级创伤认证前后儿童中度或重度创伤性脑损伤（TBI）的质量指标，包括急性外科和紧急干预的频率以及资源利用情况。
方法
这是一项回顾性研究，纳入了根据国际疾病分类代码确定为中度或重度 TBI 的年龄小于 18 岁的患者。我院于 2013 年获得 ACS 一级创伤认证。通过非参数检验比较 ACS 前（2003 年 6 月至 2008 年 5 月）、中期（2008 年 6 月至 2013 年 5 月）和 ACS 后（2013 年 6 月至 2018 年 5 月）期间的结果。使用 Cochran-Armitage 检验对分类数据和线性回归对连续变量进行线性趋势检验。
结果
共有 677 名中度或重度 TBI 患儿（ACS 前组 125 例，中期组 198 例，ACS 后组 354 例）。ACS 后组任何外科干预的频率（12.2%）明显高于中期组（5.1%）和 ACS 前组（5.6%，P=0.007）。与中期和 ACS 前组相比，更多的 ACS 后组患儿需要颅内压监测（P=0.017）、外部脑室引流（P=0.003）或气管插管（P=0.001）。研究期间，手术到手术室的时间（P=0.514）、减压频率（P=0.096）或减压时间（P=0.788）均无显著变化。与中期和 ACS 前组相比，ACS 后组的头部 CT 中位时间明显缩短（26 分钟；四分位距 [IQR]，9-60）（P<0.001）。与中期和 ACS 前组相比，ACS 后组重复头部 CT 频率明显降低（30.2%）（P=0.044）。
结论
过渡到 ACS 一级创伤认证与中度或重度 TBI 患儿的质量指标改善相关。
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