院前休克指数和收缩压对小儿大量输血具有高度特异性。
Prehospital shock index and systolic blood pressure are highly specific for pediatric massive transfusion.
机构信息
From the Department of Trauma and Emergency Surgery (C.S.Z., M.B., S.G., A.C.M., B.J.E., R.B.J., L.L., S.E.N., R.M.S., D.H.J.), University of Texas Health Science Center, San Antonio, Texas; Trauma Surgery (D.P.), Naval Medical Center Camp Lejeune, Camp Lejeune, North Carolina; University Hospital in San Antonio (T.C.-P., S.E.), Trauma Services; Department of Pathology (L.J.G.), University of Texas Health Science Center; Southwest Texas Regional Advisory Council (R.S.); and Department of Emergency Health Sciences (C.J.W.), University of Texas Health Science Center, San Antonio, Texas.
出版信息
J Trauma Acute Care Surg. 2021 Oct 1;91(4):579-583. doi: 10.1097/TA.0000000000003275.
BACKGROUND
While massive transfusion protocols (MTPs) are associated with decreased mortality in adult trauma patients, there is limited research on the impact of MTP on pediatric trauma patients. The purpose of this study was to compare pediatric trauma patients requiring massive transfusion with all other pediatric trauma patients to identify triggers for MTP activation in injured children.
METHODS
Using our level I trauma center's registry, we retrospectively identified all pediatric trauma patients from January 2015 to January 2018. Massive transfusion (MT) was defined as infusion of 40 mL/kg of blood products in the first 24 hours of admission. Patients missing prehospital vital sign data were excluded from the study. We retrospectively collected data including demographics, blood utilization, variable outcome data, prehospital vital signs, prehospital transport times, and Injury Severity Scores. Statistical significance was determined using Mann-Whitney U test and χ2 test. p Values of less than 0.05 were considered significant.
RESULTS
Thirty-nine (1.9%) of the 2,035 pediatric patients met the criteria for MT. All-cause mortality in MT patients was 49% (19 of 39 patients) versus 0.01% (20 of 1996 patients) in non-MT patients. The two groups significantly differed in Injury Severity Score, prehospital vital signs, and outcome data.Both systolic blood pressure (SBP) of <100 mm Hg and shock index (SI) of >1.4 were found to be highly specific for MT with specificities of 86% and 92%, respectively. The combination of SBP of <100 mm Hg and SI of >1.4 had a specificity of 94%. The positive and negative predictive values of SBP of <100 mm Hg and SI of >1.4 in predicting MT were 18% and 98%, respectively. Based on positive likelihood ratios, patients with both SBP of <100 mm Hg and SI of >1.4 were 7.2 times more likely to require MT than patients who did not meet both of these vital sign criteria.
CONCLUSION
Pediatric trauma patients requiring early blood transfusion present with lower blood pressures and higher heart rates, as well as higher SIs and lower pulse pressures. We found that SI and SBP are highly specific tools with promising likelihood ratios that could be used to identify patients requiring early transfusion.
LEVEL OF EVIDENCE
Therapeutic/care management, level V.
背景
虽然大量输血方案（MTP）与成人创伤患者的死亡率降低有关，但关于 MTP 对儿科创伤患者的影响的研究有限。本研究的目的是比较需要大量输血的儿科创伤患者和所有其他儿科创伤患者，以确定儿童受伤时 MTP 激活的触发因素。
方法
使用我们的一级创伤中心的登记处，我们回顾性地确定了 2015 年 1 月至 2018 年 1 月期间的所有儿科创伤患者。大量输血（MT）定义为入院后 24 小时内输注 40 mL/kg 的血液制品。排除了缺少院前生命体征数据的患者。我们回顾性地收集了数据，包括人口统计学、血液利用、可变结果数据、院前生命体征、院前转运时间和损伤严重程度评分。使用 Mann-Whitney U 检验和 χ2 检验确定统计学意义。p 值小于 0.05 被认为具有统计学意义。
结果
39 名（1.9%）2035 名儿科患者符合 MT 的标准。MT 患者的全因死亡率为 49%（39 名患者中的 19 名），而非 MT 患者为 0.01%（1996 名患者中的 20 名）。两组在损伤严重程度评分、院前生命体征和结果数据方面存在显著差异。收缩压（SBP）<100mmHg 和休克指数（SI）>1.4 均被发现对 MT 具有高度特异性，特异性分别为 86%和 92%。SBP<100mmHg 和 SI>1.4 的组合特异性为 94%。SBP<100mmHg 和 SI>1.4 预测 MT 的阳性和阴性预测值分别为 18%和 98%。基于阳性似然比，同时存在 SBP<100mmHg 和 SI>1.4 的患者比不符合这两个生命体征标准的患者更有可能需要 MT，可能性是后者的 7.2 倍。
结论
需要早期输血的儿科创伤患者的血压较低，心率较高，SI 较高，脉压较低。我们发现，SI 和 SBP 是具有较高特异性的工具，其阳性似然比具有很大的应用潜力，可以用于识别需要早期输血的患者。
证据水平
治疗/护理管理，5 级。
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