Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
Pediatr Emerg Care. 2021 Apr 1;37(4):e196-e202. doi: 10.1097/PEC.0000000000002352.
To estimate rates of critical medical and neurosurgical interventions and resource utilization for children with traumatic intracranial hemorrhage (ICH).
This was a retrospective study of children younger than 18 years hospitalized in 1 of 35 hospitals in the Pediatric Health Information System from 2009 to 2019 for ICH. We defined critical intervention as a critical medical (hyperosmotic agents and intubation) or neurosurgical intervention. We determined rates of critical interventions, intensive care unit (ICU) admission, and repeat neuroimaging. We used hierarchical logistic regression to identify high-level factors associated with undergoing critical interventions, controlling for hospital-level effects.
There were 12,714 children with ICH included in the study. Median (interquartile range) age was 4.3 (0.7-11.0) years. Twelve percent (n = 1470) of children underwent a critical clinical intervention. Critical medical interventions occurred in 10% (n = 1219), and neurosurgical interventions occurred in 3% (n = 419). Intensive care unit admission occurred in 44% (n = 5565), whereas repeat neuroimaging occurred in 40% (n = 5072). Among ICU patients, 79% (n = 4366) did not undergo a critical intervention. Of the 11,244 children with no critical interventions, 39% (n = 4366) underwent ICU admission, and 37% (n = 4099) repeat neuroimaging. After controlling for hospital, children with isolated subdural (P = 0.013) and isolated subarachnoid (P < 0.001) hemorrhage were less likely to receive critical interventions.
Critical medical interventions occurred in 10% of children with ICH, and neurosurgical interventions occurred in 3%. Intensive care unit admission and repeat neuroimaging are common, even among those who did not undergo critical interventions. Selective utilization of ICU admission and repeat neuroimaging in children who are at low risk of requiring critical interventions could improve overall quality of care and decrease unnecessary resource utilization.
评估创伤性颅内出血（ICH）患儿关键医疗和神经外科干预措施的发生率以及资源利用情况。
本研究为回顾性研究，纳入 2009 年至 2019 年期间在儿科健康信息系统（PHIS）35 家医院中的 1 家医院住院的 18 岁以下儿童，其ICH 诊断明确。我们将关键干预定义为关键医疗（高渗药物和气管插管）或神经外科干预。我们确定了关键干预措施、重症监护病房（ICU）入住率和重复神经影像学检查的发生率。我们使用分层逻辑回归确定与接受关键干预相关的高水平因素，同时控制医院层面的影响。
本研究共纳入 12714 例 ICH 患儿。中位（四分位间距）年龄为 4.3（0.7-11.0）岁。12%（n=1470）的患儿接受了关键临床干预。10%（n=1219）的患儿接受了关键医疗干预，3%（n=419）的患儿接受了神经外科干预。44%（n=5565）的患儿入住 ICU，40%（n=5072）的患儿进行了重复神经影像学检查。在 ICU 患儿中，79%（n=4366）未接受关键干预。在 11244 例未接受关键干预的患儿中，39%（n=4366）入住 ICU，37%（n=4099）进行了重复神经影像学检查。在控制医院因素后，单纯硬膜下血肿（P=0.013）和单纯蛛网膜下腔出血（P<0.001）患儿接受关键干预的可能性较低。
10%的 ICH 患儿接受了关键医疗干预，3%的患儿接受了神经外科干预。即使在未接受关键干预的患儿中，ICU 入住和重复神经影像学检查也很常见。在低风险需要关键干预的患儿中，选择性利用 ICU 入住和重复神经影像学检查，可能会提高整体医疗质量并减少不必要的资源利用。
