Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Department of Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers, NJ, USA.
J Pediatr Surg. 2024 Jul;59(7):1309-1314. doi: 10.1016/j.jpedsurg.2024.03.017. Epub 2024 Mar 16.
Guidelines for blunt liver and spleen injury (BLSI) by the Arizona-Texas-Oklahoma-Memphis-Arkansas Consortium (ATOMAC) emphasize hemodynamic stability over injury grade when considering non-operative management (NOM). In this study, we examined rates of intensive care unit (ICU) admission for children with isolated low-risk BLSI among US hospitals.
The National Trauma Data Bank (NTDB) was queried for patients ages 1-15 admitted between 2017 and 2019 with BLSI. Patients with penetrating injuries and/or concomitant non-abdominal injuries with AIS score ≥3 were excluded. Isolated BLSI was considered low-risk if the patient had normal admission vitals and did not require operative intervention. Primary outcomes measured were ICU admission, ICU length of stay (LOS), and overall LOS.
5777 patients ages 15 and under presented with isolated BLSI during the study period. 2031/5777 (35.2%) were considered low-risk. Low-risk patients had lower rates of ICU admission compared to high-risk patients (30.9% vs. 41.6%, p < 0.001) and had shorter ICU LOS (median 2 days vs. 2, p < 0.001) and shorter overall LOS (median 41 h vs. 54, p < 0.001). Pediatric verified and non-pediatric verified trauma centers had similar rates of ICU admission (36.8% vs. 38.9%, p = 0.11).
Further work is needed to capture opportunities for reduction in ICU utilization in isolated BLSI.
III.
亚利桑那-得克萨斯-俄克拉荷马-孟菲斯-阿肯色联盟（ATOMAC）的钝性肝脾损伤（BLSI）指南强调，在考虑非手术治疗（NOM）时，应优先考虑血流动力学稳定性而非损伤程度。本研究旨在调查美国各医院收治的孤立性低危 BLSI 患儿入住重症监护病房（ICU）的比例。
通过国家创伤数据库（NTDB）查询 2017 年至 2019 年期间收治的年龄在 1-15 岁的 BLSI 患者。排除穿透性损伤和/或伴有 AIS 评分≥3 的非腹部损伤的患者。若患者入院时生命体征正常且无需手术干预，则认为孤立性 BLSI 为低危。主要观察指标为 ICU 入住率、ICU 住院时间（LOS）和总 LOS。
研究期间共有 5777 名年龄在 15 岁及以下的患者出现孤立性 BLSI。其中 2031/5777（35.2%）被认为是低危。与高危患者相比，低危患者 ICU 入住率较低（30.9% vs. 41.6%，p<0.001），ICU LOS 较短（中位数 2 天 vs. 2，p<0.001），总 LOS 较短（中位数 41 小时 vs. 54 小时，p<0.001）。经儿科验证和非儿科验证的创伤中心 ICU 入住率相似（36.8% vs. 38.9%，p=0.11）。
需要进一步研究以寻找降低孤立性 BLSI 患者 ICU 使用率的机会。
III。
