Hough Michelle, Nahmias Jeffry, Santos Jeffrey, Swentek Lourdes, Bristow Robert, Butler Jennifer, Grigorian Areg
University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA.
Heliyon. 2024 Sep 28;10(19):e38707. doi: 10.1016/j.heliyon.2024.e38707. eCollection 2024 Oct 15.
Most pregnant trauma patients (PTPs) present after motor vehicle collision (MVC). The national rate and risk factors for emergency cesarean section (ECS) during the index hospitalization for pregnant trauma patients (PTPs) are unknown. We sought to investigate the national rate of ECS in PTPs presenting after MVC, hypothesizing a higher risk of ECS among those with severe injuries or elevated shock index (SI).
The 2020-2021 TQIP was queried for PTPs presenting after MVC. PTPs that underwent ECS were compared to patients that did not undergo ECS. Elevated SI was defined as ≥1. Severe injury was defined by abbreviated injury scale grade ≥3. Bivariate and multivariable logistic regression analyses were performed.
From 1183 PTPs, 95 (8.0 %) underwent ECS. The median time to ECS was 115 min. The ECS group had higher rates of lung (27.4 % vs. 12.2 %, p < 0.001) injury, spleen (18.9 % vs. 5.5 %, p < 0.001) injury, and elevated SI (22.1 % vs. 9.8 %, p < 0.001). ECS patients had higher rates of complication (9.5 % vs. 2.1 %, p < 0.001) and death (4.2 % vs. 1.1 %, p = 0.012). Independently associated risk factors for ECS included severe head (OR 2.65, CI 1.14-6.17, p = 0.023) or abdominal (OR 2.07, CI 1.08-3.97, p = 0.028) injuries and elevated SI (OR 2.17 CI 1.25-3.79, p = 0.006).
The national rate of ECS among PTPs presenting after MVC is 8 % with most occurring within the first 2 hours of arrival. Severe head and abdominal injuries as well as elevated SI are risk factors for ECS.
大多数怀孕创伤患者（PTPs）在机动车碰撞（MVC）后就诊。怀孕创伤患者（PTPs）在首次住院期间进行急诊剖宫产（ECS）的全国发生率和风险因素尚不清楚。我们试图调查MVC后就诊的PTPs中ECS的全国发生率，并假设重伤或休克指数（SI）升高的患者发生ECS的风险更高。
查询2020 - 2021年创伤质量改进计划（TQIP）中MVC后就诊的PTPs。将接受ECS的PTPs与未接受ECS的患者进行比较。SI升高定义为≥1。重伤定义为简明损伤定级（AIS）≥3级。进行双变量和多变量逻辑回归分析。
在1183例PTPs中，95例（8.0%）接受了ECS。至ECS的中位时间为115分钟。ECS组肺部损伤发生率（27.4%对12.2%，p < 0.001）、脾脏损伤发生率（18.9%对5.5%，p < 0.001）和SI升高发生率（22.1%对9.8%，p < 0.001）更高。ECS患者的并发症发生率（9.5%对2.1%，p < 0.001）和死亡率（4.2%对1.1%，p = 0.012）更高。ECS的独立相关风险因素包括严重头部损伤（比值比[OR] 2.65，95%置信区间[CI] 1.14 - 6.17，p = 0.023）或腹部损伤（OR 2.07，CI 1.08 - 3.97，p = 0.028）以及SI升高（OR 2.17，CI 1.25 - 3.79，p = 0.006）。
MVC后就诊的PTPs中ECS的全国发生率为8%，大多数发生在到达后的前2小时内。严重头部和腹部损伤以及SI升高是ECS的风险因素。
