Department of Surgery, Duke University Medical Center, Durham, North Carolina.
Department of Surgery, Duke University Medical Center, Durham, North Carolina.
J Surg Res. 2023 Nov;291:633-639. doi: 10.1016/j.jss.2023.07.018. Epub 2023 Aug 3.
Most injured children receive trauma care outside of a pediatric trauma center. Differences in physiology, dosing, and injury pattern limit extrapolation of adult trauma principles to pediatrics. We compare US trauma center experience with pediatric and adult trauma resuscitation.
We queried the 2019 Trauma Quality Improvement Program to describe the experience of US trauma centers with pediatric (<15 y) and adult trauma. We quantified blunt, penetrating, burn, and unspecified traumas and compared minor, moderate, severe, and critical traumas (ISS 1-8 Minor, ISS 9-14 Moderate, ISS 15-24 Severe, ISS 25+ Critical). We estimated center-level volumes for adults and children. Institutional identifiers were generated based on unique center specific factors including hospital teaching status, hospital type, verification level, pediatric verification level, state designation, state pediatric designation, and bed size.
A total of 755,420 adult and 76,449 pediatric patients were treated for traumatic injuries. There were 21 times as many critical or major injuries in adults compared to children, 17 times more moderate injuries, and 6 times more minor injuries. Children and adults presented with similar rates of blunt trauma, but penetrating injuries were more common in adults and burn injuries were more common in children. Comparing center-level data, adult trauma exceeded pediatric for every severity and mechanism.
There is relatively limited exposure to high-acuity pediatric trauma at US centers. Investigation into pediatric trauma resuscitation education and simulation may promote pediatric readiness and lead to improved outcomes.
大多数受伤的儿童在儿科创伤中心之外接受创伤治疗。由于生理学、用药剂量和损伤模式的差异，成人创伤原则不能直接应用于儿科。我们比较了美国创伤中心对儿科和成人创伤复苏的经验。
我们查询了 2019 年创伤质量改进计划，以描述美国创伤中心治疗儿科（<15 岁）和成人创伤的经验。我们量化了钝器伤、穿透伤、烧伤和未特指伤，并比较了轻伤、中度伤、重伤和危重伤（ISS 1-8 分为轻伤，ISS 9-14 分为中度伤，ISS 15-24 分为重伤，ISS 25+为危重伤）。我们估计了成人和儿童的中心级别容量。机构标识符是根据独特的中心特定因素生成的，包括医院教学状态、医院类型、验证级别、儿科验证级别、州指定、州儿科指定和床位大小。
共有 755420 名成人和 76449 名儿科患者因创伤性损伤接受治疗。成人中危重症或重大损伤的比例是儿童的 21 倍，中度损伤的比例是儿童的 17 倍，轻度损伤的比例是儿童的 6 倍。儿童和成人的钝器伤发生率相似，但成人的穿透伤更常见，儿童的烧伤更常见。比较中心级别的数据，成人创伤在每个严重程度和机制上都超过了儿科。
美国中心相对较少接触高风险儿科创伤。对儿科创伤复苏教育和模拟的研究可能会促进儿科准备，并改善治疗结果。
