使用院前反向休克指数乘以格拉斯哥昏迷评分来识别需要最紧急创伤治疗的儿童。
Use of prehospital reverse shock index times Glasgow Coma Scale to identify children who require the most immediate trauma care.
机构信息
From the Department of Surgery (M.L.R.), The Mount Sinai Hospital, New York, New York; Children's Hospital Center for Research in Outcomes for Children's Surgery (E.C.), Children's Hospital Colorado, Aurora, Colorado; Pediatric Surgery (M.M.N., B.D.L., L.T.G., S.J., S.L.M., D.D.B., S.N.A.), Children's Hospital Colorado; Division of Pediatric Surgery, Department of Surgery (B.D.L., L.T.G., S.L.M., D.D.B., S.N.A.), University of Colorado School of Medicine, Aurora, Colorado; Department of Surgery (J.S.), Louisiana State University Health Sciences Center, New Orleans, Louisiana; and Pediatric Surgery, Denver Health (D.D.B.), Denver, Colorado.
出版信息
J Trauma Acute Care Surg. 2023 Sep 1;95(3):347-353. doi: 10.1097/TA.0000000000003903. Epub 2023 Mar 11.
BACKGROUND
Appropriate prehospital trauma triage ensures transport of children to facilities that provide specialized trauma care. There are currently no objective and generalizable scoring tool for emergency medical services to facilitate such decisions. An abnormal reverse shock index times Glasgow Coma Scale (rSIG), which is calculated using readily available parameters, has been shown to be associated with severely injured children. This study sought to determine if rSIG could be used in the prehospital setting to identify injured children who require the highest levels of care.
METHODS
Patients (1-18 years old) transferred from the scene to a level 1 pediatric trauma center from 2010 to 2020 with complete prehospital and emergency department vital signs, and Glasgow Coma Scale (GCS) scores were included. Reverse shock index times GCS was calculated as previously described ((systolic blood pressure/heart rate) × GCS), and the following cutoffs were used: ≤13.1, ≤16.5, and ≤20.1 for 1- to 6-, 7- to 12-, and 13- to 18-year-old patients, respectively. Trauma activation level and clinical outcomes upon arrival to the pediatric trauma center were collected.
RESULTS
There were 247 patients included in the analysis; 66.0% (163) had an abnormal prehospital rSIG. Patients with an abnormal rSIG had a higher rate of highest-level trauma activation compared with those with a normal rSIG (38.7% vs. 20.2%, p = 0.013). Patients with an abnormal prehospital rSIG also had higher rates of intubation (28.8% vs. 9.52%, p < 0.001), intracranial pressure monitor (9.20 vs. 1.19%, p = 0.032), need for blood (19.6% vs. 8.33%, p = 0.034), laparotomy (7.98% vs. 1.19%, p = 0.039), and intensive care unit admission (54.6% vs. 40.5%, p = 0.049).
CONCLUSION
Reverse shock index times GCS may assist emergency medical service providers in early identification and triage of severely injured children. An abnormal rSIG in the emergency department is associated with higher rates of intubation, need for blood transfusion, intracranial pressure monitoring, laparotomy, and intensive care unit admission. Use of this metric may help to speed the identification, care, and treatment of any injured child.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
适当的院前创伤分诊可确保将儿童送往提供专业创伤护理的机构。目前，紧急医疗服务部门还没有客观的、可推广的评分工具来协助做出此类决策。一项使用容易获得的参数计算的异常反向休克指数乘以格拉斯哥昏迷评分（rSIG）与严重受伤的儿童相关。本研究旨在确定 rSIG 是否可用于院前环境，以识别需要最高级别护理的受伤儿童。
方法
纳入了自 2010 年至 2020 年从现场转运至一级儿科创伤中心的 1-18 岁患者，这些患者具有完整的院前和急诊科生命体征和格拉斯哥昏迷评分（GCS）。反向休克指数乘以 GCS 按如下方式计算：（收缩压/心率）×GCS），并使用以下切点：对于 1-6 岁、7-12 岁和 13-18 岁的患者，分别为≤13.1、≤16.5 和≤20.1。收集创伤激活水平和到达儿科创伤中心后的临床结果。
结果
分析纳入了 247 例患者；66.0%（163 例）的患者院前 rSIG 异常。与 rSIG 正常的患者相比，rSIG 异常的患者具有更高的最高级别创伤激活率（38.7% vs. 20.2%，p=0.013）。rSIG 异常的患者气管插管率更高（28.8% vs. 9.52%，p<0.001），颅内压监测率更高（9.20% vs. 1.19%，p=0.032），需要输血的比率更高（19.6% vs. 8.33%，p=0.034），需要剖腹手术的比率更高（7.98% vs. 1.19%，p=0.039），需要入住重症监护病房的比率更高（54.6% vs. 40.5%，p=0.049）。
结论
反向休克指数乘以 GCS 可能有助于急救医疗服务提供者早期识别和分诊严重受伤的儿童。急诊科 rSIG 异常与气管插管、输血、颅内压监测、剖腹手术和入住重症监护病房的比率升高相关。使用该指标可能有助于加快对任何受伤儿童的识别、护理和治疗。
证据水平
预后和流行病学；IV 级。
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