Park Flora S, Nahmias Jeffry, Shin Jordan, Li Ji Young, Barrios Cristobal, Schubl Sebastian, Grigorian Areg
Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine School of Medicine, 3800 Chapman Ave. #6200, Orange, CA 92868, USA.
Surg Open Sci. 2025 Apr 17;26:22-26. doi: 10.1016/j.sopen.2025.04.003. eCollection 2025 Jun.
Pregnancy introduces unique anatomical and physiological changes that could influence injury susceptibility, including redistribution of abdominal organs and adipose tissue that could provide a protective "cushion effect" against penetrating trauma. This study aimed to understand how injury patterns and clinical outcomes differ between pregnant trauma patients (PTPs) and their non-pregnant counterparts presenting after penetrating trauma, hypothesizing that PTPs have a lower mortality risk and incur less severe abdominal injuries due to the proposed cushion effect.
The 2020-2021 Trauma Quality Improvement Program database was queried for all female patients <50-years-old presenting after penetrating trauma. The primary outcome was mortality, and secondary outcomes included the incidence of gunshot wounds and abdominal injuries. We compared pregnant versus non-pregnant patients with bivariate and multivariable logistic regression analyses.
From 25,812 female patients, 531 (2.1 %) were PTPs. Gunshot wounds were more prevalent among PTPs (64.2 % vs. 46.0 %, < 0.001), and PTPs exhibited a higher incidence of gastrointestinal injuries (8.5 % vs. 6.3 %, = 0.04). PTPs also had more in-hospital cardiac arrests (2.1 % vs. 1.0 %, = 0.02) and increased mortality (7.5 % vs. 5.6 %, = 0.052) however similar associated risk of death (OR = 1.08, CI 0.65-1.77, = 0.78) compared to non-pregnant patients.
The prevalence of firearm violence emphasizes the need for targeted primary preventive strategies for PTPs. Furthermore, the heightened vulnerability of PTPs to gastrointestinal injuries following penetrating trauma, potentially attributed to the gravid uterus's spatial changes, challenges any proposed "cushion effect."
怀孕会带来独特的解剖学和生理学变化，这些变化可能会影响受伤易感性，包括腹部器官和脂肪组织的重新分布，这可能会对穿透性创伤起到保护性的“缓冲作用”。本研究旨在了解怀孕创伤患者（PTPs）与穿透性创伤后就诊的非怀孕患者的损伤模式和临床结果有何不同，假设由于拟议的缓冲作用，PTPs的死亡风险较低且腹部损伤较轻。
查询2020 - 2021年创伤质量改进计划数据库，获取所有50岁以下穿透性创伤后就诊的女性患者。主要结局是死亡率，次要结局包括枪伤和腹部损伤的发生率。我们通过双变量和多变量逻辑回归分析比较了怀孕患者与非怀孕患者。
在25812名女性患者中，531名（2.1%）为PTPs。枪伤在PTPs中更为普遍（64.2%对46.0%，<0.001），且PTPs的胃肠道损伤发生率更高（8.5%对6.3%，=0.04）。PTPs在医院内发生心脏骤停的情况也更多（2.1%对1.0%，=0.02），死亡率有所增加（7.5%对5.6%，=0.052），然而与非怀孕患者相比，死亡相关风险相似（OR = 1.08，CI 0.65 - 1.77，=0.78）。
枪支暴力的普遍性强调了针对PTPs制定有针对性的一级预防策略的必要性。此外，PTPs在穿透性创伤后对胃肠道损伤的易感性增加，这可能归因于妊娠子宫的空间变化，对任何拟议的“缓冲作用”提出了挑战。
