儿科创伤中心的指定对因枪伤而休克的儿童重要吗？一项创伤质量改进计划分析。
Does pediatric trauma center designation matter for children in shock from gunshot wounds? A Trauma Quality Improvement Program analysis.
作者信息
Gomez Micaela K, Wood Elizabeth C, Forssten Maximilian Peter, Williams Timothy K, Forssten Md Sebastian Peter, Sarani Babak, Mohseni Shahin, Neff Lucas P
机构信息
From the Department of Vascular Surgery (M.K.G.), Wake Forest University, Winston-Salem, North Carolina; Department of General Surgery (M.K.G.), University of Arizona, Tucson, Arizona; Department of Surgery (E.C.W.), Wake Forest School of Medicine, Winston Salem, North Carolina; Department of Orthopedic Surgery (M.P.F.), Orebro University Hospital, Sweden, School of Medical Sciences, Orebro University, Sweden; Department of Vascular and Endovascular Surgery (T.K.W.), Wake Forest School of Medicine, Winston Salem, North Carolina; Department of Orthopedic Surgery (S.P.F.), Orebro University Hospital, Orebro, Sweden; Center of Trauma and Critical Care (B.S.), George Washington University, Washington, DC; Department of Surgery, School of Medical Sciences (S.M.), Orebro University, Sweden; and Department of Pediatric Surgery (L.P.N.), Wake Forest School of Medicine, Winston-Salem, North Carolina.
出版信息
J Trauma Acute Care Surg. 2025 Sep 1;99(3):426-432. doi: 10.1097/TA.0000000000004637. Epub 2025 Jun 10.
BACKGROUND
Recent studies have demonstrated improved outcomes for severely injured pediatric trauma patients treated at pediatric trauma centers (PTCs). Nonetheless, specific injury patterns requiring immediate lifesaving intervention may offset the recognized benefits of PTC over adult trauma centers (ATCs). This study aims to compare the clinical outcomes of hypotensive pediatric trauma patients with gunshot wounds (GSWs), based on trauma center type. We hypothesize that outcomes are equivalent for this clinical scenario.
METHODS
The 2013-2021 Trauma Quality Improvement Program data set was used to identify all hypotensive pediatric patients (15 years or younger) with GSWs. Hypotension was defined per Pediatric Advanced Life Support Guidelines. Patients with an Abbreviated Injury Scale score of 6 in any region and transferred patients were excluded. In order to identify the association between PTC verification status and outcomes, Poisson regression models with robust standard errors were used.
RESULTS
A total of 687 patients met the criteria for analysis, and 236 (34%) cases were treated at PTCs. Pediatric trauma center patients were slightly younger (lower quartile, 10 vs. 12 years old; p = 0.037). There was no significant difference in Injury Severity Score or crude mortality rates (68.1% vs. 70.8%, p = 0.524). After adjusting for confounders, Poisson regression showed no reduction in in-hospital mortality, complications, failure to rescue, intensive care unit admission, or mechanical ventilation rates at PTCs compared with ATCs.
CONCLUSION
Gunshot wounds in children pose unique clinical challenges. Majority of cases are cared for at ATCs. Analysis of best available data did not demonstrate a benefit to managing these patients at a PTC. Conversely, ATCs were not superior, despite managing this scenario in both adults and children more often. These findings underscore the importance of ATCs in the care of this particular injury pattern and call attention to the recent pediatric readiness requirements for American College of Surgeons (ACS)-verified trauma centers to treat pediatric firearm injuries at both PTCs and ATC.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
背景
近期研究表明，在儿科创伤中心（PTC）接受治疗的严重受伤儿童创伤患者的治疗效果有所改善。尽管如此，需要立即进行挽救生命干预的特定损伤模式可能会抵消PTC相对于成人创伤中心（ATC）所公认的优势。本研究旨在比较基于创伤中心类型的低血压儿童创伤枪伤（GSW）患者的临床结局。我们假设在这种临床情况下结局是等效的。
方法
使用2013 - 2021年创伤质量改进计划数据集来识别所有患有GSW的低血压儿科患者（15岁及以下）。低血压根据儿科高级生命支持指南定义。任何区域简明损伤量表评分为6分的患者以及转院患者被排除。为了确定PTC核实状态与结局之间的关联，使用了具有稳健标准误的泊松回归模型。
结果
共有687例患者符合分析标准，其中236例（34%）在PTC接受治疗。儿科创伤中心的患者年龄稍小（下四分位数，10岁对12岁；p = 0.037）。损伤严重程度评分或粗死亡率无显著差异（68.1%对70.8%，p = 0.524）。在对混杂因素进行调整后，泊松回归显示与ATC相比，PTC的院内死亡率、并发症、未能挽救、重症监护病房入院率或机械通气率没有降低。
结论
儿童枪伤带来独特的临床挑战。大多数病例在ATC接受治疗。对现有最佳数据的分析未显示在PTC治疗这些患者有任何益处。相反，ATC也不具有优势，尽管其更常处理成人和儿童的这种情况。这些发现强调了ATC在处理这种特定损伤模式中的重要性，并提请注意美国外科医师学会（ACS）认证的创伤中心最近对PTC和ATC治疗儿童火器伤的儿科准备要求。
证据水平
治疗/护理管理；三级。
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