Pediatric Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas.
Trauma Department, Children's Health, Dallas, Texas.
J Emerg Med. 2021 May;60(5):583-590. doi: 10.1016/j.jemermed.2020.12.001. Epub 2021 Jan 22.
Trauma care per Advanced Trauma Life Support addresses immediate threats to life. Occasionally, delays in injury diagnosis occur. Delayed diagnosis of injury (DDI) is a common quality indicator in trauma care, and pediatric DDI data are sparse.
Our aim was to describe the DDI rate in a severely injured pediatric trauma population and identify any factors associated with DDI in the pediatric population.
A prospective cohort of trauma activations in 0- to 16-year-old patients admitted to a pediatric level I trauma center over 12 months with injuries prospectively recorded were followed during admission to identify DDI.
A total of 170 trauma activations were enrolled. Twelve patients had type I DDI (7.1%), 15 patients had type II DDI (8.8%), and 5 patients had both type I and type II DDI (2.9%). DDI patients had twice as many injuries and higher Injury Severity Scores (ISS) as non-DDI patients. DDI patients were more likely to require intensive care unit (ICU) admission, longer hospital stay, and ventilator support. Controlling for age and ISS in multivariate analysis, the number of injuries found and requiring a ventilator were significantly associated with DDI.
This prospective study found a type I DDI rate of 7.1% and a type II DDI rate of 8.8% in the pediatric population. DDI patients had a greater number of injuries, higher ISS, higher rate of ICU admission, and were more likely to require mechanical ventilation. This study adds prospective data to the pediatric DDI literature, increases provider awareness of pediatric DDI, and lays the foundation for future study and quality improvement.
根据高级创伤生命支持的创伤护理可解决对生命的即刻威胁。但偶尔会出现损伤诊断延迟的情况。损伤延迟诊断（DDI）是创伤护理中的常见质量指标，且儿科 DDI 数据较为匮乏。
本研究旨在描述严重创伤儿科患者的 DDI 发生率，并确定儿科人群中与 DDI 相关的任何因素。
对 12 个月内在小儿一级创伤中心因受伤而被激活的 0 至 16 岁患者进行前瞻性队列研究，前瞻性记录受伤情况，在患者住院期间进行随访以明确 DDI。
共纳入 170 次创伤激活。12 例患者存在 I 型 DDI（7.1%），15 例患者存在 II 型 DDI（8.8%），5 例患者同时存在 I 型和 II 型 DDI（2.9%）。DDI 患者的损伤数量更多，损伤严重程度评分（ISS）更高。与非 DDI 患者相比，DDI 患者更有可能需要入住重症监护病房（ICU）、住院时间更长和需要呼吸机支持。在多变量分析中控制年龄和 ISS 后，发现的损伤数量和需要呼吸机支持与 DDI 显著相关。
本前瞻性研究发现儿科人群的 I 型 DDI 发生率为 7.1%，II 型 DDI 发生率为 8.8%。DDI 患者的损伤数量更多，ISS 更高，ICU 入住率更高，更有可能需要机械通气。本研究为儿科 DDI 文献增加了前瞻性数据，提高了医护人员对儿科 DDI 的认识，并为未来的研究和质量改进奠定了基础。
