From the Department of Emergency Medicine, (M.S., T.A., I.T.), Yokohama City University, Yokohama, Kanagawa, Japan; Advanced Critical Care and Emergency Center, (T.A., I.T.) Yokohama City University Medical Center, Yokohama, Kanagawa, Japan; and Department of Critical Care and Emergency Medicine, (M.S.) National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan.
J Trauma Acute Care Surg. 2024 Apr 1;96(4):628-633. doi: 10.1097/TA.0000000000004114. Epub 2023 Jul 21.
Rapid identification of the severity of injuries in the field is important to ensure appropriate hospital care for better outcomes. Vital signs are used as a field triage tool for critically ill or injured patients in prehospital settings. Several studies have shown that recording vital signs, especially blood pressure, in pediatric patients is sometimes omitted in prehospital settings compared with that in adults. However, little is known about the association between the lack of measurement of prehospital vital signs and patient outcomes. In this study, we examined the association between the rate of vital sign measurements in the field and patient outcomes in injured children.
This study analyzed secondary data from the Japan Trauma Data Bank. We included pediatric patients (0-17 years) with injuries who were transported by emergency medical services. Hospital survival was the primary outcome. We performed a propensity-matched analysis with nearest-neighbor matching without replacement by adjusting for demographic and clinical variables to evaluate the effect of recording vital signs.
During the study period, 13,413 pediatric patients were included. There were 9,187 and 1,798 patients with and without prehospital blood pressure records, respectively. After matching, there were no differences in the patient characteristics or disease severity. Hospital mortality was significantly higher in the nonrecorded group than in the recorded group (4.3% vs. 1.1%; p < 0.001). The multiple logistic regression analysis results showed no prehospital record of blood pressure being associated with death (odds ratio [OR], 6.82; 95% confidence interval [CI], 2.40-19.33). Glasgow Coma Scale score and Injury Severity Score were also associated with death (OR, 0.71; 95% CI, 0.63-0.81 and OR, 1.10; 95% CI, 1.06-11.14, respectively).
Pediatric patients without any blood pressure records in prehospital settings had higher mortality rates than those with prehospital blood pressure records.
Therapeutic/Care Management; Level III.
在现场快速识别损伤的严重程度对于确保为患者提供适当的医院护理以获得更好的结果至关重要。生命体征被用作院前环境中危重症或受伤患者的现场分诊工具。多项研究表明，与成人相比，在院前环境中记录生命体征（特别是血压）有时会在儿科患者中被忽略。然而，对于院前生命体征测量的缺乏与患者结局之间的关联知之甚少。在这项研究中，我们研究了现场生命体征测量率与受伤儿童患者结局之间的关系。
本研究分析了日本创伤数据库的二次数据。我们纳入了由紧急医疗服务机构转运的受伤儿科患者（0-17 岁）。医院生存率是主要结局。我们通过不替换的最近邻匹配进行倾向评分匹配分析，同时调整人口统计学和临床变量，以评估记录生命体征的效果。
在研究期间，纳入了 13413 名儿科患者。分别有 9187 名和 1798 名患者有和没有院前血压记录。匹配后，患者特征和疾病严重程度无差异。未记录组的医院死亡率明显高于记录组（4.3%比 1.1%；p<0.001）。多变量逻辑回归分析结果显示，院前未记录血压与死亡相关（比值比[OR]，6.82；95%置信区间[CI]，2.40-19.33）。格拉斯哥昏迷量表评分和损伤严重程度评分也与死亡相关（OR，0.71；95%CI，0.63-0.81 和 OR，1.10；95%CI，1.06-11.14）。
在院前环境中没有任何血压记录的儿科患者的死亡率高于有院前血压记录的患者。
治疗/护理管理；III 级。
