Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study
Is Whole-Body CT Associated With Reduced In-Hospital Mortality in Children With Trauma? A Nationwide Study
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DOI：
10.1097/pcc.0000000000001898
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发表时间：
2019-06-01
影响因子：
4.1
通讯作者：
Tamiya, Nanako
中科院分区：
文献类型：
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作者：
Abe, Toshikazu;Aoki, Makoto;Tamiya, Nanako
设计：一项多中心的回顾性队列研究。设置：来自日本183个三级急救医疗中心的全国创伤登记。患者：我们纳入了2004-2014年间接受全身CT或选择性CT检查的16岁以下的儿童创伤患者。干预：我们将接受头部、胸部、腹部和骨盆CT检查的患者分为全身CT组和选择性CT组，如果他们至少接受一次，但不是全部，测量和主要结果：我们分析了9,170名符合条件的患者的数据(男性，6,362[69%]；中位年龄，9岁[6-12岁]。其中3501人(38%)接受了全身CT检查。住院病死率为2.0%(180/9 170)，其中全身CT组为102/3 501例(2.9%)，选择性CT组为78/5 669(1.4%)。调整多水平Logistic回归和倾向性评分匹配后，全身CT组与选择性CT组的住院死亡率差异无统计学意义。调整后的住院死亡率优势比(全身CT与选择性CT)如下：多水平Logistic回归模型1(1.05[95%CI，0.70~1.56])；多水平Logistic回归模型2(0.72[95%CI，0.44~1.17])；倾向得分匹配模型1(0.98[95%CI，0.65~1.47])；倾向得分匹配模型2(0.71[95%CI，0.46~1.08])。亚组分析也显示CT选择与住院死亡率相似。结论：在这项全国性研究中，日本创伤儿童经常使用全身CT。然而，与使用选择性CT相比，我们的结果并不支持使用全身CT来降低住院死亡率。对于儿童创伤患者，选择性使用成像可能会导致较少的辐射暴露，并提供比全身CT更多的好处。
Objectives: We aimed to investigate whether whole-body CT for children with trauma is associated with a different mortality than only selective CT.Design: A multicenter, retrospective cohort study.Setting: Nationwide trauma registry from 183 tertiary emergency medical centers in Japan.Patients: We enrolled pediatric trauma patients less than 16 years old who underwent whole-body CT or selective CT from 2004 to 2014.Interventions: We classified the patients into a whole-body CT group if they underwent head, chest, abdomen, and pelvis CT and a selective CT group if they underwent at least one, but not all, of the above scans.Measurements and Main Results: We analyzed data from 9,170 eligible patients (males, 6,362 [69%]; median age, 9 yr [6-12 yr]). Of these, 3,501 (38%) underwent whole-body CT. The overall inhospital mortality was 180 of 9,170 (2.0%), that of patients who underwent whole-body CT was 102 of 3,501 (2.9%), and that of patients who underwent selective CT was 78 of 5,669 (1.4%). After adjusted multilevel logistic regressions and propensity score matching, the whole-body CT group demonstrated no significant difference in terms of in-hospital mortality compared with the selective CT group. The adjusted odds ratios (whole-body CT vs selective CT) for in-hospital mortality were as follows: multilevel logistic regression model 1 (1.05 [95% CI, 0.70-1.56]); multilevel logistic regression model 2 (0.72 [95% CI, 0.44-1.17]); propensity score-matched model 1 (0.98 [95% CI, 0.65-1.47]); and propensity score-matched model 2 (0.71 [95% CI, 0.46-1.08]). Subgroup analyses also revealed similarities between CT selection and in-hospital mortality.Conclusions: In this nationwide study, whole-body CT was frequently used among Japanese children with trauma. However, compared with the use of selective CT, our results did not support the use of whole-body CT to reduce in-hospital mortality. Selective use of imaging may result in less radiation exposure and provide more benefits than whole-body CT to pediatric trauma patients.