Zitek Tony, Antevy Peter, Garay Sebastian, Thorn Megan, Buckley Emily, Coyle Charles, Scheppke Kenneth A, Farcy David A
Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida.
Department of Emergency Medicine and Critical Care, Herbert Wertheim College of Medicine at Florida International University, Miami, Florida.
Prehosp Emerg Care. 2025;29(6):776-781. doi: 10.1080/10903127.2024.2398185. Epub 2024 Sep 18.
Although the proximal tibia is a common site for intraosseous (IO) line placement in pediatric patients, previously published data indicate high malposition rates in infants and children at this location. Although distal femur IO lines generally demonstrate higher flow rates than those at the proximal tibia, to date, there have been no published studies assessing distal femur IO access in pediatric patients. Thus, we aimed to compare the success rates of pediatric IO line insertion attempts between the proximal tibia and the distal femur in a prehospital setting.
We conducted a retrospective chart review of prehospital pediatric patients who underwent at least one IO line placement attempt by Palm Beach County Fire Rescue from May 2015 to January 2024. We excluded records lacking specific documentation of IO attempt location. We compared the unadjusted success rates of distal femur to proximal tibia, and we also compared success rates after propensity score matching and multivariable logistic regression. Secondarily, we assessed the prehospital complication rate of the IO lines at each anatomical site.
We identified 163 pediatric patients who had an IO attempt and were eligible for analysis. Median age was 1.9 years (IQR: 0.46 to 4.2 years). Among those 163 patients, there were 234 vascular access attempts, including 82 IO attempts at the distal femur and 72 at the proximal tibia. The unadjusted success rate of distal femur attempts was 89.0%, compared to 84.7% for proximal tibia attempts, a difference of 4.3% (95% CI -6.4 to 15.0%). After propensity score matching, we found an adjusted odds ratio of 2.0 (95% CI 0.66 to 6.8), favoring the distal femur for successful placement. Prehospital complication rates were similar for distal femur (5.5%) and proximal tibia (4.9%).
This retrospective analysis of pediatric patients in a prehospital setting suggests that IO line placement at the distal femur might offer a marginally higher success rate compared to the proximal tibia. Despite not reaching statistical significance, these findings support the consideration of distal femur as a viable option for IO placement in the pediatric population.
尽管胫骨近端是儿科患者骨内（IO）置管的常见部位，但先前发表的数据表明婴儿和儿童在此部位的错位率很高。虽然股骨远端IO置管的流速通常高于胫骨近端，但迄今为止，尚无已发表的研究评估儿科患者股骨远端的IO置管情况。因此，我们旨在比较院前环境中儿科患者胫骨近端和股骨远端IO置管尝试的成功率。
我们对2015年5月至2024年1月期间由棕榈滩县消防救援部门进行至少一次IO置管尝试的院前儿科患者进行了回顾性病历审查。我们排除了缺乏IO尝试位置具体记录的记录。我们比较了股骨远端与胫骨近端的未调整成功率，还比较了倾向得分匹配和多变量逻辑回归后的成功率。其次，我们评估了每个解剖部位IO置管的院前并发症发生率。
我们确定了163例进行了IO尝试且符合分析条件的儿科患者。中位年龄为1.9岁（四分位间距：0.46至4.2岁）。在这163例患者中，共进行了234次血管通路尝试，其中包括82次股骨远端IO置管尝试和72次胫骨近端IO置管尝试。股骨远端尝试的未调整成功率为89.0%，胫骨近端尝试的成功率为84.7%，相差4.3%（95%可信区间 -6.4至15.0%）。倾向得分匹配后，我们发现调整后的优势比为2.0（95%可信区间0.66至6.8），表明股骨远端置管成功的可能性更大。股骨远端（5.5%）和胫骨近端（4.9%）的院前并发症发生率相似。
这项对院前儿科患者的回顾性分析表明，与胫骨近端相比，股骨远端IO置管的成功率可能略高。尽管未达到统计学显著性，但这些发现支持将股骨远端视为儿科人群IO置管的可行选择。
