Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA.
Center for Children's Surgery, Children's Hospital Colorado, Aurora, CO, USA.
Am J Surg. 2022 Jul;224(1 Pt A):13-17. doi: 10.1016/j.amjsurg.2022.02.054. Epub 2022 Feb 21.
Adolescents with blunt solid organ injuries (BSOI) are cared for at both pediatric trauma centers (PTC) and adult trauma centers (ATC). Over the past decade, treatment strategies have shifted towards non-operative management with reported favorable outcomes. The aim of this study was to compare management strategies and outcomes between PTC and ATC.
We queried the 2016-2018 Trauma Quality Improvement Program (TQIP) datasets to identify adolescents between the ages of 16 and 19 with BSOI. Characteristics were stratified by center type (pediatric or adult) for comparative analyses. Separate logistic regressions were used to assess the association of hospital type, location of injury, age, gender, weight, Glascow Coma Score (GCS), Injury Severity Score (ISS), and intensive care unit (ICU) admissions for outcomes of interest.
Among the 3,011,310 patients enrolled in the 2016-2018 TQIP datasets, 106,892 (3.5%) had a BSOI ICD9/10 code. Of those, 9,193 (8.6%) were between 16 and 19 years of age and included in this analysis. Within this cohort, 6,073 (66.1%) were managed at an ATC and 3,120 (33.9%) were managed at a PTC. While statistically different, there were no clinically relevant differences for age, weight, and sex between groups. A significantly higher ISS and lower GCS score were observed among those admitted to ATC compared to PTC. ICU admissions were more frequent at ATC. Number of blood transfusions by 4 h after presentation were also higher among those admitted to an ATC. Despite a lower ISS and higher GCS at presentation, mortality was higher among those treated at a PTC with an odds ratio (95% confidence interval) of 2.42 (1.31-4.53). After excluding adolescents with a traumatic brain injury, a common cause of mortality among adolescent trauma patients, these differences in outcomes persisted.
Our data suggest that adolescents with BSOI managed at a PTC are less likely to receive blood transfusions by 4 h of admission or be admitted to the ICU than those managed at an ATC. However, this more conservative approach may come at the expense of higher overall mortality. Further work is needed to understand these differences and determine if PTC need to be more aggressive in managing BSOI.
患有钝性实体器官损伤（BSOI）的青少年在儿科创伤中心（PTC）和成人创伤中心（ATC）均可得到治疗。在过去的十年中，治疗策略已转向非手术治疗，报告的结果较为有利。本研究的目的是比较 PTC 和 ATC 之间的治疗策略和结果。
我们查询了 2016-2018 年创伤质量改进计划（TQIP）数据集，以确定年龄在 16 至 19 岁之间患有 BSOI 的青少年。按中心类型（儿科或成人）对特征进行分层，以进行比较分析。单独的逻辑回归用于评估医院类型，损伤部位，年龄，性别，体重，格拉斯哥昏迷评分（GCS），损伤严重程度评分（ISS）和重症监护病房（ICU）入院与感兴趣的结局之间的关联。
在 2016-2018 年 TQIP 数据集中登记的 3011310 名患者中，有 106892 名（3.5％）具有 BSOI ICD9/10 代码。其中，有 9193 名（8.6％）年龄在 16 至 19 岁之间，包括在本分析中。在该队列中，有 6073 名（66.1％）在 ATC 接受治疗，有 3120 名（33.9％）在 PTC 接受治疗。尽管存在统计学差异，但两组之间的年龄，体重和性别没有明显的临床差异。与 PTC 相比，在 ATC 接受治疗的患者的 ISS 更高，GCS 评分更低。在 ATC 接受治疗的患者中，ICU 入院率更高。与在 PTC 接受治疗的患者相比，在 ATC 接受治疗的患者在入院后 4 小时内输血的次数也更高。尽管入院时的 ISS 较低且 GCS 较高，但在 PTC 接受治疗的患者的死亡率更高，其比值比（95％置信区间）为 2.42（1.31-4.53）。在排除了青少年创伤患者中常见的创伤性脑损伤后，这些结局差异仍然存在。
我们的数据表明，在 PTC 接受治疗的患有 BSOI 的青少年在入院后 4 小时内接受输血或入住 ICU 的可能性低于在 ATC 接受治疗的青少年。但是，这种更为保守的方法可能会导致总体死亡率更高。需要进一步的研究来了解这些差异，并确定 PTC 是否需要更积极地治疗 BSOI。
