Hemodynamic significance of pediatric femur fractures
Hemodynamic significance of pediatric femur fractures
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DOI：
10.1016/s0022-3468(96)90827-1
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发表时间：
1996-10-01
影响因子：
2.4
通讯作者：
Gains, B
中科院分区：
文献类型：
--
作者：
Lynch, JM;Gardner, MJ;Gains, B
目的：确定儿童股骨骨折后是否发生血流动力学上的明显出血。方法：回顾病历，收集I级儿科创伤中心30个月内所有确诊为股骨骨折的患者的人口统计学和损伤数据。纳入的患者包括多系统损伤和唯一的股骨骨折患者。评估血液动力学不全的发生率、输血的原因和时机，以及红细胞压积水平随时间的变化。结果：共确诊儿童178例(股骨骨折182例)。男116例，女62例，年龄1个月~19岁，平均6.04±-4.5岁。受伤原因包括跌倒(46例)、行人/机动车事故(43例)、机动车撞车(19例)、运动事故(22例)、虐待(10例)和其他(38例)。平均损伤严重程度评分(ISS)为5.88±3.93(4~29分)。没有人死亡。住院天数为8.13±9.37天(1~43天)。院前治疗包括早期制动。骨折治疗是根据公认的基于年龄、大小和骨折形态的矫形技术进行的。急诊科24小时平均红细胞压积为34%+/-3.5%(27.8%~44.4%)和32%+/-6.6%(16.9%~47.8%)。多发伤67例(38%)。平均ISS为9.4+/-5.0(5~29分)。入院时有4名患者存在血流动力学障碍。均为多发伤组。67名患者中有7人(10%)需要输血--前24小时内有3人需要输血(2人在急诊科[与面部/头皮严重出血有关]，1人在手术室[与严重肝损伤有关])，前24小时后需要输血4人(3人与术中矫形手术有关，1人与血胸有关)。接受输血者的平均年龄为8.29±4.79岁，平均ISS为13.71±4.61。所有需要输血的病人都是在汽车撞车事故或行人/机动车事故中受伤的。111名儿童分离出闭合性股骨骨折。这组患者中没有血液动力学不全或需要输血的证据。初始平均红细胞压积为34.5%±2.7%，24小时平均红细胞压积为34.6%±3.2%。我们发现(1)单纯性闭合性股骨骨折的儿童没有血液动力学不稳定的证据，或表现为24小时红细胞压积下降的显著失血，以及(2)在本系列中，只有在多发损伤的儿童中才能发现血流动力学不足和/或需要输血的证据。结论：儿童血液动力学不稳定或红细胞压积下降的证据不应归因于闭合性股骨骨折，必须找到其他失血来源。版权所有(C)1996年，由W.B.Saunders公司
Purpose: To determine whether hemodynamically significant bleeding occurs after pediatric femur fractures. Method: A retrospective chart review was performed; demographic and injury data were collected for all patients with the diagnosis of femur fracture over a 30-month period at a level I pediatric trauma center. Included were patients with multisystem injury and patients with femur fractures as the only injury. The incidence of hemodynamic insufficiency, the reasons for and timing of transfusions, and the changes in hematocrit levels over time were evaluated. Results: One hundred seventy-eight children were identified (182 femur fractures). There were 116 boys and 62 girls, and the mean age was 6.04 +/- 4.5 years (range, 1 month to 19 years). The mechanisms of injury included falls (46), pedestrian/motor vehicle accidents (43), motor vehicle crashes (19), sports accidents (22), abuse (10), and miscellaneous (38). The mean Injury Severity Score (ISS) was 5.88 +/- 3.93 (range, 4 to 29). There were no deaths. The length of hospital stay was 8.13 +/- 9.37 days (range, 1 to 43 days). Prehospital treatment included early immobilization. Fracture treatment was according to recognized orthopedic techniques based on age, size, and fracture configuration. The mean hematocrit in the emergency department was 34% +/- 3.5% (range, 27.8% to 44.4%) and 32% +/- 6.6% (range, 16.9% to 47.8%) at 24 hours. 67 patients (38%) suffered multiple injuries. Mean ISS for this group was 9.4 +/- 5.0 (range, 5 to 29). Four patients had hemodynamic insufficiency at the time of admission. All were in the multiple-injury group. Seven of these 67 patients (10%) required transfusion-three in the first 24 hours (two in the emergency department [associated with severe facial/scalp bleeding] and one in the operating room [associated with severe liver injury]) and four after the first 24 hours (three associated with intraoperative orthopedic procedures and one with a hemothorax). The mean age of those who underwent transfusion was 8.29 +/- 4.79 years, and their mean ISS was 13.71 +/- 4.61. All patients who required transfusion had been injured in motor vehicle crashes or in pedestrian/motor vehicle accidents. One hundred eleven children had isolated closed femur fractures. No patient in this group had evidence of hemodynamic insufficiency or required transfusion. The initial mean hematocrit was 34.5% +/- 2.7%, and the mean 24-hour hematocrit was 34.6% +/- 3.2%. We found that (1) no child with an isolated closed femur fracture had evidence of hemodynamic instability, or showed significant blood loss as evidenced by a decreasing hematocrit at 24 hours, and (2) in this series, evidence of hemodynamic insufficiency and/or the need for transfusion was found only in multiply injured children. Conclusion: Hemodynamic instability or evidence of a declining hematocrit in the child should not be attributed to a closed femur fracture and that other sources of blood loss must be found. Copyright (C) 1996 by W.B. Saunders Company