Department of General Medicine, Juntendo University, Tokyo.
Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi.
Medicine (Baltimore). 2021 Mar 5;100(9):e25014. doi: 10.1097/MD.0000000000025014.
Although transfusion is a primary life-saving technique, the assessment of transfusion requirements in children with trauma at an early stage is challenging. We aimed to develop a scoring system for predicting transfusion requirements in children with trauma.This was a case-control study that employed a nationwide registry of patients with trauma (Japan Trauma Data Bank) and included patients aged <16 years with blunt trauma between 2004 and 2015. An assessment of blood consumption score for pediatrics (ped-ABC score) was developed based on previous literatures and clinical relevance. One point was assigned for each of the following criteria: systolic blood pressure ≤90 mm Hg, heart rate ≥120/min, Glasgow coma scale (GCS) score <15, and positive focused assessment with sonography for trauma (FAST) scan. For sensitivity analysis, we assessed age-adjusted ped-ABC scores using cutoff points for different ages.Among 5943 pediatric patients with trauma, 540 patients had transfusion within 24 hours after trauma. The in-hospital mortality rate was 2.6% (145/5615). The transfusion rate increased from 7.6% (430/5631) to 35.3% (110/312) in patients with systolic blood pressure ≤90 mm Hg (1 point), from 6.1% (276/4504) to 18.3% (264/1439) in patients with heart rate ≥120/min (1 point), from 4.1% (130/3198) to 14.9% (410/2745) in patients with disturbance of consciousness with GCS score <15 (1 point), and from 7.4% (400/5380) to 24.9% (140/563) in patients with positive FAST scan (1 point). Ped-ABC scores of 0, 1, 2, 3, and 4 points were associated with transfusion rates of 2.2% (48/2210), 7.5% (198/2628), 19.8% (181/912), 53.3% (88/165), and 89.3% (25/28), respectively. After age adjustment, c-statistic was 0.76 (95% confidence interval, 0.74-0.78).The ped-ABC score using vital signs and FAST scan may be helpful in predicting the requirement for transfusion within 24 hours in children with trauma.
虽然输血是一种主要的救生技术，但在早期评估创伤儿童的输血需求具有挑战性。我们旨在开发一种评分系统，以预测创伤儿童的输血需求。
这是一项病例对照研究，利用了全国性的创伤患者登记处（日本创伤数据库），纳入了 2004 年至 2015 年期间患有钝性创伤且年龄<16 岁的患者。基于先前的文献和临床相关性，开发了儿科血液消耗评分（ped-ABC 评分）。符合以下标准之一即可得 1 分：收缩压≤90mmHg，心率≥120/min，格拉斯哥昏迷评分（GCS）<15，阳性的创伤超声重点评估（FAST）扫描。为了进行敏感性分析，我们使用不同年龄的截断值评估了年龄调整后的 ped-ABC 评分。
在 5943 名患有创伤的儿科患者中，有 540 名患者在创伤后 24 小时内进行了输血。院内死亡率为 2.6%（145/5615）。收缩压≤90mmHg（1 分）的患者的输血率从 7.6%（430/5631）增加到 35.3%（110/312），心率≥120/min（1 分）的患者从 6.1%（276/4504）增加到 18.3%（264/1439），GCS 评分<15 的意识障碍患者（1 分）从 4.1%（130/3198）增加到 14.9%（410/2745），FAST 扫描阳性患者（1 分）从 7.4%（400/5380）增加到 24.9%（140/563）。Ped-ABC 评分为 0、1、2、3 和 4 分的患者的输血率分别为 2.2%（48/2210）、7.5%（198/2628）、19.8%（181/912）、53.3%（88/165）和 89.3%（25/28）。经过年龄调整后，C 统计量为 0.76（95%置信区间，0.74-0.78）。
使用生命体征和 FAST 扫描的 ped-ABC 评分可能有助于预测创伤儿童在 24 小时内的输血需求。
