犹他州儿科创伤网络是一个全州性的儿科创伤合作组织，可以安全地帮助非儿科医院收治轻度创伤性脑损伤患儿。
The Utah Pediatric Trauma Network, a statewide pediatric trauma collaborative can safely help nonpediatric hospitals admit children with mild traumatic brain injury.
机构信息
From the Division of Pediatric Surgery, Department of Surgery (S.J.F., R.A.S., K.L., K.W.R.), University of Utah School of Medicine; and Utah Pediatric Trauma Network (M.E.), Utah Department of Health, Salt Lake City, Utah.
出版信息
J Trauma Acute Care Surg. 2023 Sep 1;95(3):376-382. doi: 10.1097/TA.0000000000003871. Epub 2023 Jan 19.
BACKGROUND
Created in 2019, the Utah Pediatric Trauma Network (UPTN) is a transparent noncompetitive collaboration of all hospitals in Utah with the purpose of improving pediatric trauma care. The UPTN implements evidence-based guidelines based on hospital resources and capabilities with quarterly review of data collected in a network-specific database. The first initiative was to help triage the care of traumatic brain injury (TBI) to prevent unnecessary transfers while ensuring appropriate care. The purpose of this study was to review the effectiveness of this network wide guideline.
METHODS
The UPTN REDCap database was retrospectively reviewed between January 2019 and December 2021. Comparisons were made between the pediatric trauma center (PED1) and nonpediatric hospitals (non-PED1) in admissions of children with very mild, mild, or complicated mild TBI.
RESULTS
Of the total 3,315 cases reviewed, 294 were admitted to a non-PED1 hospital and 1,061 to the PED1 hospital with very mild/mild/complicated mild TBI. Overall, kids treated at non-PED1 were older (mean, 14.9 vs. 7.7 years; p = 0.00001) and more likely to be 14 years or older (37% vs. 24%, p < 0.00001) compared with those at PED1. Increased admissions occurred post-UPTN at non-PED1 hospitals compared with pre-UPTN (43% vs. 14%, p < 0.00001). Children admitted to non-PED1 hospitals post-UPTN were younger (9.1 vs. 15.7 years, p = 0.002) with more kids younger than 14 years (67% vs. 38%, p = 0.014) compared with pre-UPTN. Two kids required next-day transfer to a higher-level center (1 to PED1), and none required surgery or neurosurgical evaluation. The mean length of stay was 21.8 hours (interquartile range, 11.9-25.4). Concomitantly, less children with very mild TBI were admitted to PED1 post-UPTN (6% vs. 27%, p < 0.00001) and more with complicated mild TBI (63% vs. 50%, p = 0.00003) than 2019.
CONCLUSION
Implementation of TBI guidelines across the UPTN successfully allowed nonpediatric hospitals to safely admit children with very mild, mild, or complicated mild TBI. In addition, admitted kids were more like those treated at the PED1 hospital.
LEVEL OF EVIDENCE
Prognostic/Epidemiological; Level IV.
背景
犹他州儿科创伤网络（UPTN）成立于 2019 年，是犹他州所有医院之间透明的非竞争合作组织，旨在改善儿科创伤护理。UPTN 根据医院资源和能力实施循证指南，并每季度审查网络特定数据库中收集的数据。第一项举措是帮助分诊创伤性脑损伤（TBI）患者的护理，以防止不必要的转院，同时确保提供适当的护理。本研究旨在回顾该网络指南的有效性。
方法
回顾 2019 年 1 月至 2021 年 12 月间 UPTN 的 REDCap 数据库。比较了儿科创伤中心（PED1）和非儿科医院（非-PED1）收治非常轻微、轻微或复杂轻微 TBI 患儿的情况。
结果
共回顾了 3315 例患者，294 例收入非-PED1 医院，1061 例收入 PED1 医院，均为非常轻微/轻微/复杂轻微 TBI。总体而言，非-PED1 医院治疗的患儿年龄较大（平均 14.9 岁 vs. 7.7 岁；p = 0.00001），14 岁及以上的患儿比例也较高（37% vs. 24%，p < 0.00001）。与 PED1 医院相比，UPTN 实施后非-PED1 医院的收治人数增加（43% vs. 14%，p < 0.00001）。UPTN 实施后，非-PED1 医院收治的患儿年龄更小（9.1 岁 vs. 15.7 岁，p = 0.002），14 岁以下患儿比例更高（67% vs. 38%，p = 0.014）。有 2 例患儿需要次日转至更高水平的中心（1 例转至 PED1），均无需手术或神经外科评估。平均住院时间为 21.8 小时（四分位间距，11.9-25.4）。与此同时，UPTN 实施后，非常轻微 TBI 患儿收治于 PED1 的比例下降（6% vs. 27%，p < 0.00001），而收治复杂轻微 TBI 的比例上升（63% vs. 50%，p = 0.00003）。
结论
在 UPTN 中实施 TBI 指南成功地使非儿科医院能够安全收治非常轻微、轻微或复杂轻微 TBI 的患儿。此外，收治的患儿更类似于 PED1 医院收治的患儿。
证据水平
预后/流行病学；IV 级。
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