与幼儿创伤再犯相关的因素。

Factors associated with trauma recidivism in young children.

机构信息

From the Division of Pediatric Surgery (C.Q.S., C.G.M., A.Y., W.M., A.R.J., C.N.), UCSF Benioff Children's Hospitals; Department of Surgery (C.Q.S., C.G.M., A.Y., W.M., A.R.J., C.N.), and Department of Epidemiology and Biostatistics (A.M.S.), University of California, San Francisco, San Francisco, California.

出版信息

J Trauma Acute Care Surg. 2024 Sep 1;97(3):421-428. doi: 10.1097/TA.0000000000004244. Epub 2024 Jan 8.

DOI:10.1097/TA.0000000000004244

PMID:38189666

Abstract

BACKGROUND

Trauma recidivism is associated with future trauma-associated morbidity and mortality. Previous evidence suggests that socioeconomic factors predict trauma recidivism in older children (10-18 years); however, risk factors in US children 10 years and younger have not been studied. We sought to determine the factors associated with trauma recidivism in young children 10 years and younger.

METHODS

We conducted a retrospective cohort study of pediatric trauma patients 10 years and younger who presented to a single American College of Surgeons-verified Level I pediatric trauma center from July 1, 2017, to June 30, 2021. All patients were evaluated for prior injury during trauma registry entry. Characteristics at the index injury were collected via chart review. Patients were geocoded to assess Social Vulnerability Index. Logistic regression examined factors associated with recidivism. Best subset selection was used to compare multivariable models and identify the most predictive and parsimonious model. Statistical significance was set at p < 0.05.

RESULTS

Of the 3,518 patients who presented in the study period, 169 (4.8%) experienced a prior injury. Seventy-six percent (n = 128) had one prior injury presentation, 18% (n = 31) had two prior presentations, and 5.9% (n = 10) had three or more. Falls were the most common mechanism in recidivists (63% vs. 52%, p = 0.009). Child physical abuse occurred in 6.5% of patients, and 0.9% experienced penetrating injury. The majority (n = 137 [83%]) were discharged home from the emergency department. There was no significant difference in the frequency of penetrating injury and child physical abuse between recidivists and nonrecidivists. Following logistic regression, the most parsimonious model demonstrated that recidivism was associated with comorbidities, age, falls, injury location, nontransfer, and racialization. No significant associations were found with Social Vulnerability Index and insurance status.

CONCLUSION

Medical comorbidities, young age, injury location, and falls were primarily associated with trauma recidivism. Support for parents of young children and those with special health care needs through injury prevention programs could reduce trauma recidivism in this population.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.

摘要

背景

创伤再入院与未来与创伤相关的发病率和死亡率有关。先前的证据表明，社会经济因素可预测年龄较大的儿童（10-18 岁）的创伤再入院；然而，美国 10 岁及以下儿童的风险因素尚未研究。我们旨在确定与 10 岁及以下幼儿创伤再入院相关的因素。

方法

我们对 2017 年 7 月 1 日至 2021 年 6 月 30 日期间在一家美国外科医师学会认证的一级儿科创伤中心就诊的 10 岁及以下儿科创伤患者进行了回顾性队列研究。所有患者在创伤登记时都接受了既往损伤的评估。通过病历回顾收集索引损伤的特征。对患者进行地理编码以评估社会脆弱性指数。逻辑回归检查了再入院的相关因素。最佳子集选择用于比较多变量模型并确定最具预测性和最简约的模型。统计学意义设定为 p < 0.05。

结果

在研究期间就诊的 3518 名患者中，有 169 名（4.8%）有既往损伤史。76%（n=128）有一次既往就诊，18%（n=31）有两次就诊，5.9%（n=10）有三次或更多就诊。再入院者中最常见的机制是跌倒（63%比 52%，p=0.009）。儿童身体虐待发生在 6.5%的患者中，0.9%的患者有穿透伤。大多数（n=137 [83%]）从急诊科出院回家。再入院者和非再入院者在穿透伤和儿童身体虐待的频率上无显著差异。经过逻辑回归，最简约的模型表明，再入院与合并症、年龄、跌倒、受伤部位、非转院和种族有关。社会脆弱性指数和保险状况与再入院无显著关联。