Harborview Injury Prevention & Research Center, University of Washington, 325 9th Ave Box 359960, Seattle, WA 98122, USA; Department of Surgery, University of Washington, 1959 NE Pacific Street, WA 98195, USA; Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA.
Center for Pediatric Trauma Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
J Pediatr Surg. 2021 Jan;56(1):146-152. doi: 10.1016/j.jpedsurg.2020.09.023. Epub 2020 Oct 6.
No guidelines exist for management of hemodynamically stable children with suspected hollow viscus injury. We sought to determine factors contributing to surgeon management of these patients.
Surgeon members of the Eastern Association for the Surgery of Trauma and American Pediatric Surgical Association completed a survey on 3 blunt abdominal injury scenarios: (1) isolated, (2) with multisystem injury, and (3) with traumatic brain injury (TBI), and a penetrating injury scenario. Multivariable logistic regression was used to determine factors associated with initial management of observation vs. operation for blunt injury and observation vs. local wound exploration versus laparoscopy for penetrating injury.
Of 394 surgeons (response rate 22.3%), 50.3% were pediatric surgeons. For scenarios 1-3, 32.2%, 49.3%, and 60.7% of surgeons chose operation over observation, respectively. Compared to isolated blunt injury, surgeons were more likely to choose operation for patients with multisystem injury (aOR 2.20, 95%CI: 1.78-2.72) or TBI (aOR 3.60, 95%CI: 2.79-4.66). Pediatric surgeons were less likely to choose operation (aOR 0.32, 95%CI: 0.22-0.44). For penetrating injury, 39.1%, 29.5%, and 31.5% of surgeons chose observation, local wound exploration, and laparoscopy, respectively.
Large variation exists in management of hemodynamically stable children with suspected hollow viscus injury. Although patient injury characteristics account for some variation, surgeon factors such as type of surgeon also play a role. Evidence-based practice guidelines should be developed to standardize care.
Cross-Sectional Survey.
N/A.
目前对于血流动力学稳定的疑似空腔脏器损伤患儿，尚无相关处理指南。本研究旨在明确影响外科医生处理此类患儿的因素。
东部创伤外科学会和美国小儿外科学会的外科医生成员对 3 种钝性腹部损伤场景（1：孤立性，2：合并多系统损伤，3：合并创伤性脑损伤（TBI））和 1 种穿透性损伤场景完成了一项调查。采用多变量逻辑回归分析确定与初始处理中观察与手术的选择、穿透性损伤中观察与局部伤口探查和腹腔镜检查的选择相关的因素。
在 394 名外科医生（回复率 22.3%）中，50.3%为小儿外科医生。对于场景 1-3，分别有 32.2%、49.3%和 60.7%的外科医生选择手术而非观察。与孤立性钝性损伤相比，外科医生更倾向于为合并多系统损伤（OR 2.20，95%CI：1.78-2.72）或 TBI（OR 3.60，95%CI：2.79-4.66）的患者选择手术。小儿外科医生更倾向于选择非手术（OR 0.32，95%CI：0.22-0.44）。对于穿透性损伤，分别有 39.1%、29.5%和 31.5%的外科医生选择观察、局部伤口探查和腹腔镜检查。
血流动力学稳定的疑似空腔脏器损伤患儿的处理存在较大差异。尽管患者的损伤特征导致了一些差异，但外科医生的因素，如外科医生的类型，也起到了一定作用。应制定基于循证的实践指南以规范治疗。
横断面调查。
无。
