Pediatric Liver Lacerations and Intensive Care: Evaluation of ICU Triage Strategies
Pediatric Liver Lacerations and Intensive Care: Evaluation of ICU Triage Strategies
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DOI：
10.1097/pcc.0000000000000102
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发表时间：
2014-05-01
影响因子：
4.1
通讯作者：
Barnhart, Douglas C.
中科院分区：
文献类型：
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作者：
Fremgen, Heather E.;Bratton, Susan L.;Barnhart, Douglas C.
目的：比较基于CT分级和/或生理不稳定性的钝性外伤性肝裂伤后PICU入住标准与实际做法，以提高ICU入住效率。设计：回顾性队列研究。背景：2002-2010年3-6级肝裂伤患者。患者：171名婴儿和儿童，年龄1个月至17岁。干预措施：无。测量和主要结果：生理不稳定的再入院前体征（即，昏迷和心脏骤停），肝脏CT分级，以及结果，包括入住ICU后的住院时间和浓缩红细胞输注。多个身体区域严重创伤定义为大于或等于1个腹部外身体区域缩写损伤评分大于或等于4。将实际ICU入院情况与预测值进行比较。2例患者在ICU入院前死亡，5例（3%）在ICU入院后死亡。在169名患者中，52名（31%）最初入住住院病房。5%的人因肝损伤接受了手术治疗。20%的人因休克而紧急接受了包装红细胞，而5%的人在入院后接受了第一次包装红细胞。与ICU入院相比，病房患者明显年龄较大，损伤严重程度评分较低，手术护理较少。在ICU患者中，失血性休克输血与更严重的损伤评分显著相关。60%的ICU患者没有输血。根据生理不稳定体征确定的ICU分诊预测了53例入院（31%），其中9例患者中有7例（78%）在入院后接受输血治疗。未输血患者的预计ICU入院率较低-9%。增加CT撕裂分级≥ 4级增加ICU入院人数至129人（76%）。在存活的ICU患者中，37/62例（60%）孤立性严重腹部创伤且无全身不稳定的患者在ICU停留时间少于1天。结论：孤立性腹部损伤且无生理性不稳定的儿童一般无需入住ICU即可进行治疗。在通常的ICU入院标准中增加≥ 4级导致稳定患者的入院过多。
Objective: To compare PICU admission criteria following blunt traumatic liver laceration based on CT grade and/or physiologic instability with actual practice to improve efficiency of ICU admission. Design: Retrospective cohort study. Setting: Patients with grade 3-6 liver lacerations, 2002-2010. Patients: Hundred seventy-one infants and children, ages 1 month to 17 years. Interventions: None. Measurements and Main Results: Preadmission signs of physiologic instability (i.e., coma and cardiac arrest), liver CT grading, and outcomes including length of stay and packed RBC transfusion after admission to ICU were collected. Multiple body region severe trauma was defined as more than or equal to 1 extra-abdominal body area abbreviated injury score more than or equal to 4. Actual ICU admissions were compared with predicted. Two patients died before ICU admission and five (3%) died afterward. Of 169 patients, 52 (31%) were initially admitted to the inpatient ward. Five percent received surgical care for liver injury. Twenty percent received packed RBCs emergently for shock, whereas 5% received their first packed RBCs after admission. Compared with ICU admissions, ward patients were significantly older, had lower Injury Severity Scores, and less operative care. Among ICU patients, transfusion for hemorrhagic shock was significantly associated with more severe injury scores. Sixty percent of ICU patients were not transfused. ICU triage determined by signs of physiologic instability predicted 53 admissions (31%) including seven of nine patients (78%) treated with transfusions after admission. Predicted ICU admission for nontransfused patients was lower-9%. Adding CT laceration grade more than or equal to 4 increased ICU admissions to 129 (76%). Among surviving ICU patients, 37 of 62 patients (60%) with isolated severe abdominal trauma and no systemic instability had ICU length of stay less than 1 day. Conclusions: Children with isolated abdominal injury and no physiologic instability can generally be treated without ICU admission. Adding grade more than or equal to 4 to usual ICU admission criteria resulted in excessive admission of stable patients.