Katsura Morihiro, Fukuma Shingo, Kuriyama Akira, Kondo Yutaka, Yasuda Hideto, Matsushima Kazuhide, Shiraishi Atsushi, Kusaka Akari, Nakabayashi Yosuke, Yagi Masayuki, Ito Fumihito, Tanikawa Atsushi, Kushimoto Shigeki
Department of Surgery, Okinawa Chubu Hospital, Okinawa, Japan; Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Pediatr Surg. 2024 Mar;59(3):500-508. doi: 10.1016/j.jpedsurg.2023.10.069. Epub 2023 Nov 4.
This study aimed to assess whether the grade of contrast extravasation (CE) on CT scans was associated with massive transfusion (MT) requirements in pediatric blunt liver and/or spleen injuries (BLSI).
This multicenter retrospective cohort study included pediatric patients (≤16 years old) who sustained BLSI between 2008 and 2019. MT was defined as transfusion of all blood products ≥40 mL/kg within the first 24 h of admission. Associations between CE and MT requirements were assessed using multivariate logistic regression analysis with cluster-adjusted robust standard errors to calculate the adjusted odds ratio (AOR).
A total of 1407 children (median age: 9 years) from 83 institutions were included in the analysis. Overall, 199 patients (14 %) received MT. CT on admission revealed that 54 patients (3.8 %) had CE within the subcapsular hematoma, 100 patients (7.1 %) had intraparenchymal CE, and 86 patients (6.1 %) had CE into the peritoneal cavity among the overall cohort. Multivariate analysis, adjusted for age, sex, age-adjusted shock index, injury severity, and laboratory and imaging factors, showed that intraparenchymal CE and CE into the peritoneal cavity were significantly associated with the need for MT (AOR: 2.50; 95 % CI, 1.50-4.16 and AOR: 4.98; 95 % CI, 2.75-9.02, respectively both p < 0.001). The latter significant association persisted in the subgroup of patients with spleen and liver injuries.
Active CE into the free peritoneal cavity on admission CT was independently associated with a greater probability of receiving MT in pediatric BLSI. The CE grade may help clinicians plan blood transfusion strategies.
Level 4; Therapeutic/Care management.
本研究旨在评估CT扫描上对比剂外渗（CE）的分级是否与小儿钝性肝和/或脾损伤（BLSI）时大量输血（MT）的需求相关。
这项多中心回顾性队列研究纳入了2008年至2019年间发生BLSI的儿科患者（≤16岁）。MT定义为入院后24小时内输注所有血液制品≥40 mL/kg。使用多因素逻辑回归分析和聚类调整稳健标准误评估CE与MT需求之间的关联，以计算调整后的优势比（AOR）。
分析纳入了来自83家机构的1407名儿童（中位年龄：9岁）。总体而言，199例患者（14%）接受了MT。入院时的CT显示，在整个队列中，54例患者（3.8%）在包膜下血肿内有CE，100例患者（7.1%）有实质内CE，86例患者（6.1%）有CE进入腹腔。在对年龄、性别、年龄调整后的休克指数、损伤严重程度以及实验室和影像学因素进行调整的多因素分析中，实质内CE和CE进入腹腔与MT需求显著相关（AOR分别为：2.50；95%CI，1.50 - 4.16和AOR：4.98；95%CI，2.75 - 9.02，两者p均<0.001）。后者的显著关联在脾和肝损伤患者亚组中持续存在。
入院CT上对比剂主动进入游离腹腔与小儿BLSI时接受MT的可能性更大独立相关。CE分级可能有助于临床医生制定输血策略。
4级；治疗/护理管理。
