影响儿童犬咬伤患者住院时间和复杂性的因素。
Factors affecting length and complexity of hospital stay in pediatric dog bite patients.
作者信息
Alessio-Bilowus Dominic, Kumar Nishant, Donoghue Lydia, Ridelman Elika, Shanti Christina
机构信息
Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Michigan, Detroit, Michigan, USA.
出版信息
Trauma Surg Acute Care Open. 2023 Jul 27;8(1):e001071. doi: 10.1136/tsaco-2022-001071. eCollection 2023.
BACKGROUND
Dog bite injuries are a source of significant morbidity and expense in the USA, and rates of hospitalization have been rising. Children are at increased risk of dog bites compared with adults, yet there is a lack of published material on factors affecting hospital course. The objective of this study is to explore factors associated with increased length of stay (LOS), more complex course of care and post-discharge return rates in this population.
METHODS
A retrospective review was conducted of all patients presenting to our urban, academic children's hospital for dog bite injuries between January 2016 and May 2021. Only those patients admitted for inpatient care were included, as identified through our institution's trauma registry, and variables were examined prior to, during, and after hospital stay.
RESULTS
739 pediatric patients in total were treated for dog bites during the study period, of which 349 were admitted. Analysis revealed two pre-admission predictors of increased LOS: bone fracture (mean LOS=5.3 days vs. 2.5 days, p=0.013) and prior medical comorbidity (4.3 days vs. 2.8 days, p=0.042). After admission, fractures were associated with a higher rate of postoperative complications (16% vs. 5.6%, p=0.014) and return (13% vs. 2.0%, p<0.001), primarily due to wound infection. Although the facial region represented the largest proportion of fractures, long bone fractures of the arm and leg were noted to have comparatively higher LOS and complication rates. Postoperative complications were not associated with any documented infection at admission.
CONCLUSIONS
Our findings suggest that long bone fractures in pediatric dog bites can be an underappreciated source of latent wound infection associated with late-presenting negative outcomes. Increased awareness of these relationships could lead to earlier detection of infection in this vulnerable population.
LEVEL OF EVIDENCE
Level III, Prognostic / Epidemiological.
背景
在美国，犬咬伤是导致严重发病和高额费用的一个原因，且住院率一直在上升。与成人相比，儿童被犬咬伤的风险更高，但缺乏关于影响住院病程因素的已发表资料。本研究的目的是探讨该人群中与住院时间（LOS）延长、护理过程更复杂以及出院后复诊率增加相关的因素。
方法
对2016年1月至2021年5月期间到我们城市的学术性儿童医院就诊的所有犬咬伤患儿进行回顾性研究。仅纳入通过我们机构的创伤登记系统确定的那些因住院治疗而入院的患者，并对住院前、住院期间和出院后的变量进行检查。
结果
在研究期间，共有739名儿科患者接受了犬咬伤治疗，其中349名入院。分析显示，住院时间延长的两个入院前预测因素为：骨折（平均住院时间=5.3天对2.5天，p=0.013）和既往合并症（4.3天对2.8天，p=0.042）。入院后，骨折与术后并发症发生率较高（16%对5.6%，p=0.014）和复诊率较高（13%对2.0%，p<0.001）相关，主要原因是伤口感染。虽然面部骨折占比最大，但手臂和腿部的长骨骨折的住院时间和并发症发生率相对较高。术后并发症与入院时任何记录在案的感染均无关联。
结论
我们的研究结果表明，儿童犬咬伤中的长骨骨折可能是潜在伤口感染的一个未被充分认识的来源，与延迟出现的不良后果相关。提高对这些关系的认识可能会导致在这一脆弱人群中更早地发现感染。
证据水平
三级，预后/流行病学。
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