Yancovich Shannon E, Guiner Alessandra, Mehmood Noormah, Nesiama Ediri, Ragle Parker, Reisch Joan S, Nesiama Jo-Ann O
Department of Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Mail Code: 9063, Dallas, TX 75390, United States of America.
Department of Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Mail Code: 9063, Dallas, TX 75390, United States of America.
Am J Emerg Med. 2025 Feb;88:197-203. doi: 10.1016/j.ajem.2024.11.062. Epub 2024 Nov 23.
Most injured children are initially seen at non-pediatric hospitals, then transferred to a pediatric trauma center for definitive care. Published outcomes of transferred children with blunt abdominal trauma (BAT) are sparse. Our objective is to describe this population and their disposition at a pediatric trauma center.
The study was performed at a level-1 pediatric trauma center (PTC) using data collected from electronic medical records and trauma registry. Patients 0-18 years with BAT transferred from outside facilities (OSF) between 2009 and 2019. Penetrating injuries were excluded. 923 patients were analyzed and grouped by whether computed tomography abdominal/pelvis (CTa/p) was obtained at each facility. Those with positive CTa/p at OSF were also compared to those with positive CTa/p results at our PTC. Descriptive statistics evaluated demographics, injury mechanism, Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), disposition, and length of stay (LOS).
Males had higher predominance of positive CTa/p at both OSF and PTC (p = 0.0012), with motor vehicle crash (MVC) being the most common injury mechanism (p = 0.0002). Patients with positive CTa/p at PTC (n = 156) were associated with statistically higher ISS, lower GCS, more dispositions to OR and ICU, and longer LOS (all p < 0.005). Of patients with negative CTa/p at OSF (n = 41), none received subsequent CTa/p upon arrival to PTC and only 2 were admitted in the setting of head trauma. Of the patients without CTa/p performed at either facility or negative CTa/p at PTC (n = 23), most were admitted for non-abdominal trauma.
Compared to those with positive CTa/p at OSF, children who had positive CTa/p at PTC were younger, had higher ISS scores, and longer LOS, suggesting they were more seriously injured. Children with BAT and negative CTa/p in absence of other injuries, may not require transfer to a PTC. Enhanced understanding of these patients may reduce unnecessary transfers, improving resource utilization.
大多数受伤儿童最初在非儿科医院就诊，然后被转至儿科创伤中心接受确定性治疗。关于钝性腹部创伤（BAT）患儿转院后的已发表研究结果较少。我们的目的是描述这一群体及其在儿科创伤中心的治疗情况。
本研究在一家一级儿科创伤中心（PTC）进行，使用从电子病历和创伤登记处收集的数据。研究对象为2009年至2019年期间从外部机构（OSF）转来的0至18岁BAT患儿。穿透性损伤被排除在外。对923例患者进行分析，并根据每家机构是否进行腹部/骨盆计算机断层扫描（CTa/p）进行分组。OSF中CTa/p阳性的患者也与我们PTC中CTa/p阳性结果的患者进行比较。描述性统计评估人口统计学、损伤机制、格拉斯哥昏迷量表（GCS）、损伤严重程度评分（ISS）、治疗情况和住院时间（LOS）。
男性在OSF和PTC中CTa/p阳性的比例更高（p = 0.0012），机动车碰撞（MVC）是最常见的损伤机制（p = 0.0002）。PTC中CTa/p阳性的患者（n = 156）在统计学上与更高的ISS、更低的GCS、更多的手术和重症监护病房（ICU）治疗以及更长的住院时间相关（所有p < 0.005）。OSF中CTa/p阴性的患者（n = 41）在到达PTC后均未接受后续CTa/p检查，只有2例因头部创伤入院。在两家机构均未进行CTa/p或PTC中CTa/p阴性的患者（n = 23）中，大多数因非腹部创伤入院。
与OSF中CTa/p阳性的儿童相比，PTC中CTa/p阳性的儿童更年轻，ISS评分更高，住院时间更长，表明他们受伤更严重。无其他损伤的BAT且CTa/p阴性的儿童可能不需要转至PTC。对这些患者的深入了解可能会减少不必要的转院，提高资源利用率。
