Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
J Pediatr Surg. 2021 Feb;56(2):401-404. doi: 10.1016/j.jpedsurg.2020.10.022. Epub 2020 Oct 24.
BACKGROUND/PURPOSE: Shock index-pediatric age-adjusted (SIPA) is a proven tool to predict outcomes in blunt pediatric trauma. We hypothesized that an elevated SIPA in either the pre-hospital or in the emergency department (ED) would identify children with blunt liver or spleen injury (BLSI) needing a blood transfusion and those at risk for failure of non-operative management (NOM).
Pediatric patients (1-18 years) in the ACS pediatric-TQIP database (2014-2016) with a BLSI were included. Patients were stratified by the need for a blood transfusion and/or abdominal operation.
A total of 3561 patients had BLSI, of which 4% received a blood transfusion, and 4% underwent an abdominal operation. Patients who received blood had higher ISS scores (27.0 vs. 5.0, p < 0.001) and mortality (22% vs. 0.4%, p < 0.001). Those who failed NOM had higher ISS scores (17.0 vs. 5.0, p < 0.001) and mortality (7.9% vs. 0.9%, p < 0.001). On multivariable regression, an elevated SIPA score in either pre-hospital or ED was significantly associated with blood transfusion (odds ratio (OR) 8.2, 95% confidence intervals (CI) 5.8-11.5, p < 0.001) and failure of NOM (OR 2.3, CI 1.5-3.4, p < 0.001).
Hemodynamic instability, represented by an elevated pre-hospital or ED SIPA, accurately identifies children with BLSI who may need blood products or an operative intervention.
Retrospective Comparative Study.
Level III.
背景/目的：休克指数-儿科年龄调整（SIPA）是一种已被证实的工具，可用于预测钝性小儿创伤的结局。我们假设，在院前或急诊部（ED）升高的 SIPA 会识别出需要输血和有非手术治疗（NOM）失败风险的钝性肝或脾损伤（BLSI）儿童。
纳入 ACS 儿科-TQIP 数据库（2014-2016 年）中患有 BLSI 的 1-18 岁儿科患者。根据是否需要输血和/或腹部手术对患者进行分层。
共有 3561 名患者患有 BLSI，其中 4%接受了输血，4%接受了腹部手术。接受输血的患者 ISS 评分更高（27.0 比 5.0，p<0.001），死亡率也更高（22%比 0.4%，p<0.001）。NOM 失败的患者 ISS 评分更高（17.0 比 5.0，p<0.001），死亡率也更高（7.9%比 0.9%，p<0.001）。多变量回归分析显示，院前或 ED 升高的 SIPA 评分与输血（优势比（OR）8.2，95%置信区间（CI）5.8-11.5，p<0.001）和 NOM 失败（OR 2.3，CI 1.5-3.4，p<0.001）显著相关。
代表血流动力学不稳定的院前或 ED SIPA 升高准确识别出可能需要血液制品或手术干预的 BLSI 儿童。
回顾性比较研究。
III 级。
