Department of Surgery, Division of Trauma and Surgical Critical Care, 14506Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, University of South Florida, Tampa, FL, USA.
Am Surg. 2022 Dec;88(12):2913-2922. doi: 10.1177/00031348211011106. Epub 2021 Apr 18.
Motor vehicle collisions (MVCs) are a major cause of pediatric morbidity and mortality. However, the effect of body mass index (BMI) and seatbelt use on thoracic injuries and outcomes in pediatric patients with rib fractures remains unexplored. We aim to assess how seatbelt use and BMI affect thoracic injuries and outcomes in pediatric patients who sustained ≥3 rib fractures following an MVC.
The Trauma Quality Improvement Program (TQIP) database (2013-2017) was queried for pediatric patients (8-17 years and >4 feet 9 inches tall) admitted secondary to MVCs, with ≥3 rib fractures and all non-thoracic Abbreviated Injury Scale ≤2. Patients were then divided by Injury Severity Score (ISS) into low (<15) and intermediate-severe (≥15) groups, which were further subdivided according to seatbelt use and BMI. Logistic and linear regression was performed to assess the effects of seatbelt use and BMI on outcomes.
Seatbelt compliance varied from 39.6 to 50.7%. Belted patients (intermediate-severe ISS) had a reduced hospital length of stay (HLOS), intensive care unit length of stay(ICU-LOS), and mechanical ventilation time but had increased odds of splenic laceration vs. unbelted patients (aOR = 2.46, 95% CI: 1.03-5.93, = .044). Obese patients (low ISS) had lower incidences of hemothorax, pneumothorax, pulmonary contusion, splenic laceration, and liver injury compared to normal-weight patients. Overweight patients (intermediate-severe ISS) had a significantly reduced ICU-LOS vs. normal-weight patients (β = -.17, 95% CI: -.33,-.01, = .041).
Seatbelt use may improve outcomes for pediatric MVC patients with ≥3 rib fractures. Higher BMI may be associated with reduced thoracic injury and decreased ICU-LOS. Effective educational initiatives are needed to increase pediatric seatbelt compliance.
机动车碰撞（MVC）是导致儿童发病率和死亡率的主要原因。然而，身体质量指数（BMI）和安全带使用对儿科肋骨骨折患者的胸部损伤和结果的影响仍未得到探索。我们旨在评估在 MVC 后发生≥3 根肋骨骨折的儿科患者中，安全带使用和 BMI 如何影响胸部损伤和结果。
使用创伤质量改进计划（TQIP）数据库（2013-2017 年）查询因 MVC 住院的儿科患者（8-17 岁，身高>4 英尺 9 英寸），至少有 3 根肋骨骨折，所有非胸部损伤严重程度评分（Abbreviated Injury Scale）≤2。然后，根据损伤严重程度评分（ISS）将患者分为低（<15）和中重度（≥15）组，根据安全带使用和 BMI 进一步细分。使用逻辑回归和线性回归评估安全带使用和 BMI 对结果的影响。
安全带使用率从 39.6%到 50.7%不等。使用安全带的患者（中重度 ISS）的住院时间（HLOS）、重症监护病房时间（ICU-LOS）和机械通气时间缩短，但与未使用安全带的患者相比，脾破裂的可能性增加（优势比=2.46，95%置信区间：1.03-5.93， =.044）。肥胖患者（低 ISS）与正常体重患者相比，发生血胸、气胸、肺挫伤、脾破裂和肝损伤的几率较低。超重患者（中重度 ISS）与正常体重患者相比，ICU-LOS 显著缩短（β=-.17，95%置信区间：-.33，-.01， =.041）。
安全带使用可能改善≥3 根肋骨骨折的儿科 MVC 患者的结果。较高的 BMI 可能与减少胸部损伤和缩短 ICU-LOS 有关。需要有效的教育计划来提高儿科安全带的使用率。
