Yamamoto Ryo, Sato Yukio, Maeshima Katsuya, Tomita Kentaro, Takemura Ryo, Katsura Morihiro, Kondo Yutaka, Yasuda Hideto, Kushimoto Shigeki, Sasaki Junichi
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
J Pediatr Surg. 2025 Mar;60(3):162106. doi: 10.1016/j.jpedsurg.2024.162106. Epub 2024 Dec 16.
We evaluated the outcomes of pediatric patients with blunt liver and spleen injury (BLSI) admitted to hospitals with pediatric intensive care units (PICUs).
A post-hoc analysis of a multicenter observational study on pediatric patients (≤16 years) with BLSI at 83 hospitals between 2008 and 2019 was conducted. Thirty-day mortality and BLSI-associated adverse events were compared between patients treated in hospitals with and without PICUs. Estimated 30-day mortality was compared, adjusting for demographics, comorbidities, injury mechanism and severity, and resuscitative treatments using inverse probability weighting.
Among 1401 patients, 421 were treated in hospitals with PICUs and 207 were admitted to a PICU. The 30-day mortality was 3 (0.7 %) and 13 (1.3 %) in patients treated in hospitals with and without PICUs, respectively, and was comparable between the patients treated in PICUs and adult ICUs (1 [0.5 %] vs. 9 [1.9 %]). The adjusted 30-day mortality was lower in patients treated in hospitals with PICUs than in those treated in hospitals with adult ICUs (3 [0.2 %] vs. 13 [1.0 %]; odds ratio 0.22 [0.06-0.79]; p = 0.012) and in those treated in PICUs than in those treated in adult ICUs (2 [0.3 %] vs. 10 [1.5 %]; odds ratio 0.22 [0.05-0.98]; p = 0.041). BLSI-related adverse events were similar regardless of the PICU availability or admission, except for emergency hemostasis of ruptured pseudoaneurysm, which was fewer in patients treated in hospitals with PICUs.
Adverse events, including 30-day mortality, were rare, regardless of PICU availability, and the adjusted 30-day mortality was lower in patients treated in PICUs.
我们评估了入住设有儿科重症监护病房（PICU）医院的钝性肝脾损伤（BLSI）儿科患者的治疗结果。
对2008年至2019年间在83家医院收治的16岁及以下BLSI儿科患者的多中心观察性研究进行事后分析。比较了在设有和未设有PICU的医院接受治疗的患者的30天死亡率和BLSI相关不良事件。使用逆概率加权法，在对人口统计学、合并症、损伤机制和严重程度以及复苏治疗进行调整后，比较了估计的30天死亡率。
在1401例患者中，421例在设有PICU的医院接受治疗，207例入住了PICU。在设有和未设有PICU的医院接受治疗的患者中，30天死亡率分别为3例（0.7%）和13例（1.3%），在PICU接受治疗的患者与成人重症监护病房（ICU）接受治疗的患者之间的死亡率相当（1例[0.5%]对9例[1.9%]）。在设有PICU的医院接受治疗的患者的调整后30天死亡率低于在设有成人ICU的医院接受治疗的患者（3例[0.2%]对13例[1.0%]；比值比0.22[0.06 - 0.79]；p = 0.012），在PICU接受治疗的患者的调整后30天死亡率也低于在成人ICU接受治疗的患者（2例[0.3%]对10例[1.5%]；比值比0.22[0.05 - 0.98]；p = 0.041）。无论是否设有PICU或患者是否入住PICU，BLSI相关不良事件相似，但破裂假性动脉瘤的紧急止血情况除外，在设有PICU的医院接受治疗的患者中较少发生。
无论是否设有PICU，包括30天死亡率在内的不良事件都很罕见，且在PICU接受治疗的患者的调整后30天死亡率较低。
