小儿钝性心脏损伤的危险因素和结局。

Risk factors and outcomes in pediatric blunt cardiac injuries.

机构信息

Division of Trauma and Critical Care, Department of Surgery, Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA.

Department of Surgery, Rhode Island Hospital, 593 Eddy Street, APC 454, Providence, RI, 02903, USA.

出版信息

Pediatr Surg Int. 2023 May 9;39(1):195. doi: 10.1007/s00383-023-05478-y.

DOI:10.1007/s00383-023-05478-y

PMID:37160488

Abstract

PURPOSE

Unlike adults, less is known of the etiology and risk factors for blunt cardiac injury (BCI) in children. Identifying risk factors for BCI in pediatric patients will allow for more specific screening practices following blunt trauma.

METHODS

A retrospective review was performed using the Trauma Quality Improvement Program (TQIP) database from 2017 to 2019. All patients ≤ 16 years injured following blunt trauma were included. Demographics, mechanism, associated injuries, injury severity, and outcomes were collected. Univariate and multivariate regression was used to determine specific risk factors for BCI.

RESULTS

Of 266,045 pediatric patients included in the analysis, the incidence of BCI was less than 0.2%. The all-cause mortality seen in patients with BCI was 26%. Motor-vehicle collisions (MVCs) were the most common mechanism, although no association with seatbelt use was seen in adolescents (p = 0.158). The strongest independent risk factors for BCI were pulmonary contusions (OR 15.4, p < 0.001) and hemothorax (OR 8.9, p < 0.001).

CONCLUSIONS

Following trauma, the presence of pulmonary contusions or hemothorax should trigger additional screening investigations specific for BCI in pediatric patients.

摘要

目的

与成年人不同，儿童钝性心脏损伤（BCI）的病因和危险因素知之甚少。确定儿科患者 BCI 的危险因素将允许在钝性创伤后进行更具体的筛查。

方法

使用创伤质量改进计划（TQIP）数据库对 2017 年至 2019 年期间进行了回顾性研究。纳入所有≤16 岁因钝性创伤受伤的患者。收集人口统计学、机制、相关损伤、损伤严重程度和结果。使用单变量和多变量回归来确定 BCI 的特定危险因素。

结果

在纳入分析的 266045 名儿科患者中，BCI 的发生率低于 0.2%。BCI 患者的全因死亡率为 26%。虽然在青少年中未发现与安全带使用相关（p=0.158），但机动车碰撞（MVC）是最常见的机制。BCI 的最强独立危险因素是肺挫伤（OR 15.4，p<0.001）和血胸（OR 8.9，p<0.001）。