儿科创伤后多器官功能障碍综合征的流行病学和结局。
Epidemiology and outcomes of multiple organ dysfunction syndrome following pediatric trauma.
机构信息
From the Harborview Injury Prevention and Research Center (E.Y.K., J.M.Z., H.L., M.S.V., R.L.N.H., F.P.R.), Division of Pediatric Critical Care Medicine, Department of Pediatrics, (E.Y.K., R.S.W.), University of Washington; Center for Child Health, Behavior, and Development (E.Y.K., R.S.W., F.P.R.), Seattle Children's Research Institute; Department of Anesthesiology and Pain Medicine (M.S.V.), University of Washington, Seattle, Washington; University Medical Center Utrecht (R.L.N.H.), Utrecht, Netherlands; and Division of General Pediatrics, Department of Pediatrics (F.P.R.), University of Washington, Seattle, Washington.
出版信息
J Trauma Acute Care Surg. 2022 Dec 1;93(6):829-837. doi: 10.1097/TA.0000000000003616. Epub 2022 Apr 1.
BACKGROUND
Existing studies have found a low prevalence of multiple organ dysfunction syndrome (MODS) in pediatric trauma patients, typically applying adult criteria to single-center pediatric cohorts. We used pediatric criteria to determine the prevalence, risk factors, and outcomes of MODS among critically injured children in a national pediatric intensive care unit (PICU) database.
METHODS
We conducted a retrospective cohort study of PICU patients 1 month to 17 years with traumatic injury in the Virtual Pediatric Systems, LLC database from 2009 to 2017. We used International Pediatric Sepsis Consensus Conference criteria to identify MODS on Day 1 of PICU admission and estimated the risk of mortality and poor functional outcome (Pediatric Overall/Cerebral Performance Category ≥3 with ≥1 point worsening from baseline) for MODS and for each type of organ dysfunction using generalized linear Poisson regression adjusted for age, comorbidities, injury type and mechanism, and postoperative status.
RESULTS
Multiple organ dysfunction syndrome was present on PICU Day 1 in 23.1% of 37,177 trauma patients (n = 8,592), with highest risk among patients with injuries associated with drowning, asphyxiation, and abuse. Pediatric intensive care unit mortality was 20.1% among patients with MODS versus 0.5% among patients without MODS (adjusted relative risk, 32.3; 95% confidence interval, 24.1-43.4). Mortality ranged from 1.5% for one dysfunctional organ system to 69.1% for four or more organ systems and was highest among patients with hematologic dysfunction (43.3%) or renal dysfunction (29.6%). Death or poor functional outcome occurred in 46.7% of MODS patients versus 8.3% of patients without MODS (adjusted relative risk, 4.3; 95% confidence interval 3.4-5.3).
CONCLUSION
Multiple organ dysfunction syndrome occurs more frequently following pediatric trauma than previously reported and is associated with high risk of morbidity and mortality. Based on existing literature using identical methodology, both the prevalence and mortality associated with MODS are higher among trauma patients than the general PICU population. Consideration of early organ dysfunction in addition to injury severity may aid prognostication following pediatric trauma.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
背景
现有的研究发现，儿科创伤患者多器官功能障碍综合征（MODS）的患病率较低，通常是将成人标准应用于单中心儿科队列。我们使用儿科标准来确定全国儿科重症监护病房（PICU）数据库中严重创伤儿童的 MODS 的患病率、危险因素和结局。
方法
我们对 2009 年至 2017 年期间，在 Virtual Pediatric Systems, LLC 数据库中 1 个月至 17 岁因创伤性损伤而入住 PICU 的患者进行了回顾性队列研究。我们使用国际儿科脓毒症共识会议标准来确定 PICU 入院第 1 天的 MODS，并使用广义线性泊松回归估计 MODS 以及每种类型的器官功能障碍（MODS 患者的儿科整体/大脑表现类别≥3 且与基线相比恶化≥1 分）和术后状态的死亡率和不良功能结局（不良功能结局）的风险。
结果
37177 例创伤患者中有 23.1%（8592 例）在 PICU 第 1 天存在 MODS，溺水、窒息和虐待相关损伤的患者风险最高。MODS 患者的 PICU 死亡率为 20.1%，而无 MODS 患者的死亡率为 0.5%（调整后的相对风险，32.3；95%置信区间，24.1-43.4）。死亡率从一个器官系统功能障碍的 1.5%到四个或更多器官系统功能障碍的 69.1%不等，血液系统功能障碍（43.3%）或肾脏功能障碍（29.6%）患者的死亡率最高。MODS 患者中死亡或不良功能结局的发生率为 46.7%，而无 MODS 患者的发生率为 8.3%（调整后的相对风险，4.3；95%置信区间 3.4-5.3）。
结论
儿科创伤后发生多器官功能障碍综合征的频率高于先前报道，并且与高发病率和死亡率相关。基于使用相同方法学的现有文献，与普通 PICU 人群相比，MODS 的患病率和死亡率在创伤患者中均较高。考虑到除损伤严重程度外，早期器官功能障碍可能有助于预测儿科创伤后的预后。
证据水平
预后和流行病学；三级。
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