小儿创伤性脑损伤中血浆输注与死亡率的限时关联。
Time-limited association between plasma transfusion and mortality in pediatric traumatic brain injury.
作者信息
Furman Leah, Feeney Erin V, Gaines Barbara A, Leeper Christine M
机构信息
From the Department of Surgery (L.F., E.V.F.), University of Pittsburgh Medical Center; Trauma and Transfusion Medicine Research Center (L.F., E.V.F., C.M.L.), University of Pittsburgh, Pittsburgh, Pennsylvania; Division of Pediatric Surgery, Department of Surgery (B.A.G.), University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Surgery and Critical Care Medicine (C.M.L.), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
出版信息
J Trauma Acute Care Surg. 2025 Jun 6. doi: 10.1097/TA.0000000000004694.
BACKGROUND
Traumatic brain injury (TBI) is a predominant cause of pediatric mortality. While prehospital plasma administration has been associated with lower mortality in adults with TBI, the impact of early plasma in children is unknown.
METHODS
In this retrospective cohort study, we examined the impact of plasma transfusion within 4 hours of arrival on 4-hour, 24-hour, and 30-day mortality in children aged 1 to 17 years with severe TBI (head Abbreviated Injury Scale scores 4 and 5) using the National Trauma Data Bank from 2020 to 2022. We excluded subjects with mild-moderate or nonsurvivable TBI or missing plasma or weight data. Cox proportional hazard models, clustered by facility, assessed the effect of early plasma on mortality, adjusting for: age; sex; trauma mechanism; interfacility transfer; shock; total Glasgow Coma Scale; Injury Severity Score; trauma center level; insurance; binary whole blood, red blood cell, and platelet administration; and weight-adjusted total 4-hour transfusion volumes.
RESULTS
Of 367,065 children in the National Trauma Data Bank from 2020 to 2022, 14,691 met the inclusion criteria, of whom 1,594 (10.9%) received early plasma. Subjects were mostly male (67.8%), with a median (interquartile range) age of 12 (5-15) years, Glasgow Coma Scale score of 11 (3-15), Injury Severity Score of 25 (17-29), and 28.7% presenting in shock. The adjusted hazard ratio (HR) for the effect of plasma administration on mortality was 0.610 (95% CI, 0.430-0.864; p = 0.005) at 4 hours, 0.894 (95% CI, 0.706-1.131; p = 0.350) at 24 hours, and 1.132 (95% CI, 0.961-1.334; p = 0.138) at 30 days.
CONCLUSION
This study reports a significant association between early plasma administration and a lower risk of 4-hour mortality among children with severe TBI that does not persist at or beyond 24 hours. While these data suggest that plasma resuscitation may extend the window for lifesaving intervention, additional prospective data are needed.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
背景
创伤性脑损伤（TBI）是儿童死亡的主要原因。虽然院前输注血浆与成年TBI患者死亡率降低有关，但早期输注血浆对儿童的影响尚不清楚。
方法
在这项回顾性队列研究中，我们利用2020年至2022年的国家创伤数据库，研究了1至17岁重度TBI（头部简明损伤量表评分为4分和5分）患儿在到达后4小时内输注血浆对4小时、24小时和30天死亡率的影响。我们排除了轻度-中度或不可存活的TBI患者，以及血浆或体重数据缺失的患者。采用按机构聚类的Cox比例风险模型评估早期输注血浆对死亡率的影响，并对以下因素进行调整：年龄；性别；创伤机制；机构间转运；休克；格拉斯哥昏迷量表总分；损伤严重程度评分；创伤中心级别；保险；全血、红细胞和血小板的二元输注；以及体重调整后的4小时总输血量。
结果
在2020年至2022年国家创伤数据库中的367,065名儿童中，14,691名符合纳入标准，其中1,594名（10.9%）接受了早期血浆输注。受试者大多为男性（67.8%），中位（四分位间距）年龄为12岁（5-15岁），格拉斯哥昏迷量表评分为11分（3-15分），损伤严重程度评分为25分（17-29分），28.7%的患者出现休克。输注血浆对死亡率影响的校正风险比（HR）在4小时时为0.610（95%CI，0.430-0.864；p=0.005），24小时时为0.894（95%CI，0.706-1.131；p=0.350），30天时为1.132（95%CI，0.961-1.334；p=0.138）。
结论
本研究报告了早期输注血浆与重度TBI患儿4小时死亡率较低之间存在显著关联，但在24小时及以后这种关联不再持续。虽然这些数据表明血浆复苏可能会延长挽救生命干预的窗口期，但仍需要更多前瞻性数据。
证据水平
治疗/护理管理；三级。
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