Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan.
BMC Emerg Med. 2020 Oct 31;20(1):86. doi: 10.1186/s12873-020-00381-4.
It remains unclear whether transcatheter arterial embolisation (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE performed in paediatric (age ≤ 15 years) and adult patients with blunt torso trauma.
This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a 'paediatric patient group' and an 'adult patient group'. The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR).
A total of 504 patients with blunt torso trauma were transported to the trauma centre, out of which 23% (N = 114) with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs 22%, P = .221). The paediatric patients' median age was 11 years (interquartile ranges 7-14). The predicted mortality rate and SMR for paediatric patients were lower than those for adult patients (18.3% vs 25.9%, P = .026, and 0.37 vs 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients who underwent surgery before TAE or urgent blood transfusion (33% vs 26%, P = .566, or 67% vs 85%, P = .084).
It is possible to provide an equal level of care related to TAE for paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. Alternative haemorrhage control procedures should be established as soon as possible whenever the patients reach a haemodynamically unstable state.
由于日本儿童创伤病例较少且偶有病例报告，经导管动脉栓塞术（TAE）在治疗儿童钝性躯干创伤方面的安全性和有效性尚不清楚，是否与成人相当。本研究旨在比较 TAE 治疗儿童（年龄≤15 岁）和成人钝性躯干创伤患者的疗效和安全性。
这是一项单中心回顾性病历研究，纳入 2012 年至 2017 年在创伤中心接受 TAE 的钝性躯干创伤患者。将比较研究分为“儿科患者组”和“成人患者组”。TAE 的转归措施包括出血控制成功率和并发症及标准化死亡率（SMR）。
共有 504 例钝性躯干创伤患者被送往创伤中心，其中 23%（N=114）接受了 TAE，包括 15 例儿科患者和 99 例成年患者。儿童和成人接受 TAE 的比例无显著差异（29% vs 22%，P=0.221）。儿科患者的中位年龄为 11 岁（四分位间距 7-14）。儿科患者的预测死亡率和 SMR 低于成年患者（18.3% vs 25.9%，P=0.026，0.37 vs 0.54）。儿科患者无需重复 TAE 或其他手术干预即可有效控制出血的比例为 93%，与成年患者相似（88%）。本中心儿科患者无并发症。两组患者在 TAE 前或紧急输血前接受手术的比例（33% vs 26%，P=0.566，或 67% vs 85%，P=0.084）或接受手术的比例无显著差异。
在创伤中心，对于有出血的钝性躯干创伤儿童和成人患者，提供 TAE 相关治疗的护理水平相当。一旦患者出现血流动力学不稳定状态，应尽快建立其他出血控制程序。
