共查询到20条相似文献，搜索用时 15 毫秒
1.
Sandra R. DiBrito Marcelo Cerullo Seth D. Goldstein Susan Ziegfeld Dylan Stewart Isam W. Nasr 《Journal of pediatric surgery》2018,53(9):1789-1794
Background
Discordant assessments of Glasgow Coma Score (GCS) following trauma can result in inappropriate triage. This study sought to determine the reliability of prehospital GCS compared to emergency department (ED) GCS.Methods
We conducted a retrospective review of traumas from 01/2000 to 12/2015 at a Level-1 pediatric trauma center. We evaluated reliability between field and ED GCS using Pearson's correlation. We ascertained the difference between prehospital and ED GCS (delta-GCS). Associations between patient characteristics and delta-GCS were modeled using Poisson and linear regression, adjusting for demographic and clinical covariates.Results
We identified 5306 patients. Pearson's correlation for GCS measurements was 0.57 for ages 0–3, and 0.67–0.77 for other age groups. Mean delta-GCS was highest for age < 3 years (0.95, SD = 2.4). Poisson regression demonstrated that compared to children 0–3 years, higher age was associated with lower delta-GCS (RR 0.65 95% CI 0.56–0.74). Linear regression showed that in those with a delta-GCS, more severe injury (higher ISS, worse ED disposition) and older age were associated with a negative change, signifying decline in score.Conclusions
GCS is generally unreliable in pediatric trauma patients aged 0–3 years, particularly the verbal score component. This may impact accuracy of triage priority for pediatric trauma patients.Level of evidence
III, Prognostic. 相似文献2.
Krista K. Wheeler Junxin Shi Henry Xiang Rajan K. Thakkar Jonathan I. Groner 《Journal of pediatric surgery》2018,53(4):765-770
Purpose
We sought to determine readmission rates and risk factors for acutely injured pediatric trauma patients.Methods
We produced 30-day unplanned readmission rates for pediatric trauma patients using the 2013 National Readmission Database (NRD).Results
In US pediatric trauma patients, 1.7% had unplanned readmissions within 30 days. The readmission rate for patients with index operating room procedures was no higher at 1.8%. Higher readmission rates were seen in patients with injury severity scores (ISS) = 16–24 (3.4%) and ISS ≥ 25 (4.9%). Higher rates were also seen in patients with LOS beyond a week, severe abdominal and pelvic region injuries (3.0%), crushing (2.8%) and firearm injuries (4.5%), and in patients with fluid and electrolyte disorders (3.9%). The most common readmission principal diagnoses were injury, musculoskeletal/integumentary diagnoses and infection. Nearly 39% of readmitted patients required readmission operative procedures. Most common were operations on the musculoskeletal system (23.9% of all readmitted patients), the integumentary system (8.6%), the nervous system (6.6%), and digestive system (2.5%).Conclusions
Overall, the readmission rate for pediatric trauma patients was low. Measures of injury severity, specifically length of stay, were most useful in identifying those who would benefit from targeted care coordination resources.Level of evidence
This is a Level III retrospective comparative study. 相似文献3.
Andrew Nordin Alan Coleman Junxin Shi Krista Wheeler Henry Xiang Shannon Acker Denis Bensard Brian Kenney 《Journal of pediatric surgery》2018,53(1):130-135
Purpose
In adults, shock index (SI; heart rate/systolic blood pressure) > 0.9 predicts injury severity and trauma outcomes. However, age-adjusted shock index (SIPA) out-performs SI in blunt trauma patients 4–16 years old. We sought to confirm these findings and expand this tool to include penetrating trauma and children aged 1–4 years.Methods
We developed cutoff values for patients 1–3 years old using age-based vital signs and queried the 2014 Pediatric Trauma Quality Improvement Program (TQIP) database for patients aged 1–16 years sustaining blunt or penetrating trauma. Outcomes measured included injury severity, transfusion within 24 h, intensive care unit (ICU) and hospital length of stay (LOS), and mortality. SI and SIPA were compared using Student's t-test and chi-square tests.Results
We identified 22,344 blunt and 613 penetrating trauma patients. SI was elevated in 41.3% and 40.0% of these groups, respectively, whereas SIPA was elevated in 15.6% and 19.4% of patients. SIPA was a significantly better predictor of transfusion needs, injury severity, ICU admission, ventilator use, and mortality for both blunt and penetrating trauma.Conclusion
SIPA identifies severe injury and predicts transfusion needs and mortality more effectively than SI for both blunt and penetrating pediatric trauma. Further investigation should evaluate its use as a triage tool.Type of study
Prognosis Study.Level of evidence
II. 相似文献4.
Emily Welker Jennifer Novak Lindsey Jelsma Tracy Koehler Alan Davis James DeCou Emily Durkin 《Journal of pediatric surgery》2018,53(10):2055-2058
Background/Purpose
Hemoglobin monitoring is required in pediatric trauma patients with solid organ injury. We hypothesized that noninvasive hemodynamic monitoring (NIHM) represents an effective, safe alternative to laboratory hemoglobin (LabHb) monitoring in clinically stable patients.Methods
A retrospective cohort study was conducted regarding pediatric trauma patients (< 18 years old) with blunt solid organ injury over six consecutive months. Continuous NIHM was initiated at the time of admission, and LabHb measurements were obtained per institutional guidelines. Measurements were correlated within two hours of assessment and patient outcomes were analyzed.Results
Twenty-one patients met inclusion criteria and had evaluable data. Blunt trauma was the exclusive mechanism of injury, and mean injury severity score was 16.6 for the cohort. Bland Altman analysis showed an average deviation of 0.80 g/dL between NIHM and LabHb values for all data pairs. Measurement trends were highly correlated in patients with stable hemoglobin levels and those requiring blood transfusion.Conclusions
NIHM demonstrated clinically acceptable accuracy when following hemoglobin trends in the defined pediatric trauma patient population. Slight variances between NIHM and LabHb values were occasionally noted, but did not affect clinical management. Continuous NIHM represents a potentially valuable adjunct to traditional laboratory hemoglobin monitoring.Level of Evidence Rating
IV. 相似文献5.
Jamie Oliver Jacob Avraham Spiros Frangos Sandra Tomita Charles DiMaggio 《Journal of pediatric surgery》2018,53(4):758-764
Background
This study provides important updates to the epidemiology of pediatric trauma in the United States.Methods
Age-specific epidemiologic analysis of the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample, representing 2.4 million pediatric traumatic injury discharges in the US from 2000 to 2011. We present yearly data with overlying loess smoothing lines, proportions of common injuries and surgical procedures, and survey-adjusted logistic regression analysis.Results
From 2000 to 2011 there was a 21.7% decline in US pediatric trauma injury inpatient discharges from 273.2 to 213.7 admissions per 100,000. Inpatient case-fatality decreased 5.5% from 1.26% (95% CI 1.05–1.47) to 1.19% (95% CI 1.01–1.38). Severe injuries accounted for 26.5% (se = 0.11) of all discharges in 2000 increasing to 31.3% (se = 0.13) in 2011. The most common injury mechanism across all age groups was motor vehicle crashes (MVCs), followed by assaults (15–19 years), sports (10–14), falls (5–9) and burns (< 5). The total injury-related, inflation-adjusted cost was $21.7 billion, increasing 56% during the study period.Conclusions
The overall rate of inpatient pediatric injury discharges across the United States has been declining. While injury severity is increasing in hospitalized patients, case-fatality rates are decreasing. MVCs remain a common source of all pediatric trauma.Levels of evidence
Level III. 相似文献6.
Lilly Bayouth Sarah Ashley Jackie Brady Bryan Lake Morgan Keeter David Schiller Walter C. Robey Stephen Charles Kari M. Beasley Eric A. Toschlog Shannon W. Longshore 《Journal of pediatric surgery》2018,53(2):367-371
Background
Outcome disparities between urban and rural pediatric trauma patients persist, despite regionalization of trauma systems. Rural patients are initially transported to the nearest emergency department (ED), where pediatric care is infrequent. We aim to identify educational intervention targets and increase provider experience via pediatric trauma simulation.Methods
Prospective study of simulation-based pediatric trauma resuscitation was performed at three community EDs. Level one trauma center providers facilitated simulations, providing educational feedback. Provider performance comfort and skill with tasks essential to initial trauma care were assessed, comparing pre-/postsimulations. Primary outcomes were: 1) improved comfort performing skills, and 2) team performance during resuscitation.Results
Provider comfort with the following improved (p-values < 0.05): infant airway, infant IV access, blood administration, infant C-spine immobilization, chest tube placement, obtaining radiographic images, initiating transport, and Broselow tape use. The proportion of tasks needing improvement decreased: 42% to 27% (p-value = 0.001). Most common deficiencies were: failure to obtain additional history (75%), beginning secondary survey (58.33%), log rolling/examining the back (66.67%), calling for transport (50%), calculating medication dosages (50%).Conclusions
Simulation-based education improves provider comfort and performance. Comparison of patient outcomes to evaluate improvement in pediatric trauma care is warranted.Level of evidence rating
IV. 相似文献7.
Sean M. Stokes Eric R. Scaife Austin M. Stevens Stephen J. Fenton 《Journal of pediatric surgery》2018,53(11):2189-2194
Background
The treatment of injured children contributes substantially to the financial burden of a health care system. The purpose of this study was to characterize these charges at a level-1 pediatric trauma center.Methods
Financial data for children (< 14 years) admitted for traumatic injury from 1/2009 to 12/2014 were analyzed. The charges of the index admission and first two years following discharge were evaluated.Results
5853 trauma patients were included with average annual charges of $11,128,730. The most common mechanisms of injury were fall (44%), sports (12%), and bike (9%). The median ISS was 6 (IQR 4–10) with a mortality rate of 1.8% and Z-score of 13.04 (p < 0.001). The overall total charges per patient during the index admission were $9513. Spinal cord and major abdominal injuries had the greatest charges per patient ($55,560 and $23,618 respectively) primarily owing to hospital LOS. During the first year after discharge, the total charges per patient were $1733, of which spinal cord injury resulted in highest overall ($19,426), owing to inpatient rehabilitation. For all other injury patterns, mean total charges per patient were $2376 (range $791-$3573).Conclusions
The value proposition in health care requires us to define outcomes relative to costs. Injury severity, major injury location, and hospital length of stay are the highest contributors for the financial burden of pediatric traumatic injury, while inpatient readmissions and inpatient rehabilitation drove higher charges in the years following discharge.Type of Study
Clinical Research Paper.Level of Evidence
II - Cohort Study. 相似文献8.
Matthew C. Hernandez Ryan M. Antiel Karthik Balakrishnan Martin D. Zielinski Denise B. Klinkner 《Journal of pediatric surgery》2018,53(2):352-356
Introduction
Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM).Methods
We reviewed pediatric multisystem trauma patients (2005–2016), comparing SGA and BVM. Primary outcome was adequacy of oxygenation and ventilation. Additional measures included tracheostomy, mortality and abbreviated injury scores (AIS).Results
Ninety patients were included (SGA, n = 17 and BVM, n = 73). SGA patients displayed increased median head AIS (5 [4–5] vs 2 [0–4], p = 0.001) and facial AIS (1 [0–2] vs 0 [0–0], p = 0.03). SGA indications were multiple failed intubation attempts (n = 12) and multiple failed attempts with poor visualization (n = 5). Median intubation attempts were 2 [1–3] whereas BVM patients had none. Compared to BVM, SGA patients demonstrated inadequate oxygenation/ventilation (75% vs 41%), increased tracheostomy rates (31% vs 8.1%), and increased 24-h (38% vs 10.8%) and overall mortality (75% vs 14%) (all p < 0.05).Conclusions
Escalating intubation attempts and severe facial AIS were associated with tracheostomy. Inadequacy of oxygenation/ventilation was more frequent in SGA compared to BVM patients. SGA patients demonstrate poor clinical outcomes; however, SGAs may be necessary in increased craniofacial injury patterns. These factors may be incorporated into a management algorithm to improve definitive airway management after SGA. 相似文献9.
Ahmed Kayssi Maged Metias Jacob C. Langer Graham Roche-Nagle Augusto Zani Thomas L. Forbes Paul Wales Sebastian K. King 《Journal of pediatric surgery》2018,53(4):771-774
Background
To describe the spectrum of noniatrogenic pediatric vascular injuries and their outcomes at a large tertiary pediatric hospital.Methods
Retrospective review of a prospectively-maintained trauma database, identifying children with noniatrogenic vascular injuries managed between 1994 and 2014.Results
A total of 198 patients were identified. Those patients with a digital or intracerebral vascular injury (92/198) were excluded from further analysis. The remaining 106 patients represented 1.2% of all traumas managed at our institution during the 21-year study period. The majority were male (75%), and between 1 and 12 years of age (71% of all patients). Median time from trauma scene to any hospital was 48 min (range 0–132), and most patients were transferred from another hospital (64%). Three patients were declared dead upon arrival (3%). Penetrating injuries accounted for most injuries (72%), while blunt injuries accounted for the remainder. Ulnar, radial, or brachial artery trauma accounted for 47% of injuries. Most vessels were treated operatively, by primary repair (49%), vessel ligation (15%), or interposition graft (12%). Fourteen patients (13%) were managed nonoperatively and most patients (74%) experienced no complications in hospital or during follow-up.Conclusion
Noniatrogenic pediatric vascular injuries are rare and represent a highly heterogeneous population. Most children recover well, with minimal perioperative complications.Level of evidence
IV (case series with no comparison group). 相似文献10.
Introduction
Traumatic pneumatoceles are reported to be rare in children and to have an uncertain clinical significance. We report a single institution series of traumatic pneumatoceles to better define their frequency and clinical significance.Methods
After obtaining approval from the IRB, data were extracted from the trauma registry of a level 1 pediatric trauma center on children diagnosed with a pulmonary contusion (International Classification of Diseases-9th edition diagnosis codes: 861.21 to 861.31) who presented between June, 2006 and September, 2016. Patient demographics, mechanism of injury, injury severity score, diagnosis and procedure codes, length of hospital stay, outcome, imaging techniques and findings with attention to the identification of a pneumatocele, were examined.Results
Of the 10,229 trauma admission, 204 children were identified as having a pulmonary contusion, 25 of whom (12.3%) were diagnosed with a pneumatocele. Their mean age was 13 years (3–17). Seventy-six percent (19) were male. The most common mechanism of injury was a motor vehicle collision (10), followed by falls (6), and sports (5). Sixteen children (64%) suffered a long bone fracture, 12 (48%) an abdominal solid organ injury and 3 (12%) a traumatic brain injury. The mean Injury Severity Score was 17 (9–34). Twenty-three patients presented as transfers. There were no fatalities. The pneumatocele was identified on chest computerized tomography (CT) alone in 15 (60%), on chest CT and chest radiograph (CXR) in 3 (12%), the upper portions of an abdominal CT in 6 (24%) and on CXR alone in 1 (4%). Seven patients were found to have a solitary pneumatocele and 18 patients had 2 or more. The largest pneumatocele was 3.7 cm in diameter. Ten children (40%) were admitted to the intensive care unit, 3 of whom required intubation. One patient (4%) had a respiratory complication: pneumonia. Three patients underwent chest tube placement for: pneumothorax, hemothorax and hemopneumothorax. No child underwent intervention specific to the pneumatocele. Seventeen (68%) patients were seen in follow-up in Trauma Clinic and the remainder by another practitioner ranging from 1 week to 6 months after injury. One child (4%) underwent a follow-up chest CT to rule out a congenital pulmonary malformation 6 months after injury and this demonstrated complete resolution of the pneumatocele.Conclusion
The incidence of traumatic pneumatoceles among children with a pulmonary contusion was 12.3% in this series, but is probably higher given that only 24% were visible on radiographs and a small minority of children with pulmonary contusions underwent chest CT. Pneumatoceles are common in children with pulmonary contusions, but are usually small. The majority do not appear to be clinically significant nor require follow-up imaging.Level of evidence
IV. 相似文献11.
Cory McLaughlin Jessica A. Zagory Michael Fenlon Caron Park Christianne J Lane Daniella Meeker Randall S. Burd Henri R. Ford Jeffrey S. Upperman Aaron R. Jensen 《Journal of pediatric surgery》2018,53(2):344-351
Background/purpose
The classic “trimodal” distribution of death has been described in adult patients, but the timing of mortality in injured children is not well understood. The purpose of this study was to define the temporal distribution of mortality in pediatric trauma patients.Methods
A retrospective cohort of patients with mortality from the National Trauma Data Bank (2007–2014) was analyzed. Categorical comparison of ‘dead on arrival’, ‘death in the emergency department’, and early (≤ 24 h) or late (> 24 h) inpatient death was performed. Secondary analyses included mortality by pediatric age, predictors of early mortality, and late complication rates.Results
Children (N = 5463 deaths) had earlier temporal distribution of death compared to adults (n = 104,225 deaths), with 51% of children dead on arrival or in ED compared to 44% of adults (p < 0.001). For patients surviving ED resuscitation, children and adolescents had a shorter median time to death than adults (1.2 d and 0.8 days versus 1.6 days, p < 0.001). Older age, penetrating mechanism, bradycardia, hypotension, tube thoracostomy, and thoracotomy were associated with early mortality in children.Conclusions
Injured children have higher incidence of early mortality compared to adults. This suggests that injury prevention efforts and strategies for improving early resuscitation have potential to improve mortality after pediatric injury.Level of evidence
Level III: Retrospective cohort study. 相似文献12.
Daniel K. Noland Nadja Apelt Cynthia Greenwell Jefferson Tweed David M. Notrica Nilda M. Garcia R. Todd Maxson James W. Eubanks Adam C. Alder 《Journal of pediatric surgery》2019,54(2):345-349
Background/Purpose
Massive transfusion protocols (MTPs) are considered valuable in pediatric trauma. Important questions regarding the survival benefit and optimal blood component ratio remain unknown.Methods
The study time frame was January 2007 through December 2013 five Level I Pediatric Trauma Centers reviewed all trauma activations involving children ≤ 18?years of age. Included were patients who either had the institutional MTP or received > 20?mL/kg or?>?2?units packed red blood cells (PRBCs).Results
110/202 qualified for inclusion. Median age was 5.9?years (3.0–11.4). 73% survived to discharge; median hospitalization was 10 (3.1–22.8) days. Survival did not vary by arrival hemoglobin (Hgb), gender or age. Partial prothrombin time (PTT), INR, GCS and injury severity score (ISS) significantly differed for nonsurvivors (all p?<?0.05). Logistic regression found increased mortality (OR 3.08 (1.10–8.57), 95% CI; p?=?0.031) per unit increase over a 1:1 ratio of pRBC:FFP.Conclusion
In pediatric trauma pRBC:FFP ratio of 1:1 was associated with the highest survival of severely injured children receiving massive transfusion. Ratios 2:1 or ≥ 3:1 were associated with significantly increased risk of death. These data support a higher proportion of plasma products for pediatric trauma patients requiring massive transfusion.Level of evidence
Level IV. 相似文献13.
14.
Barbara E. Coons Sophia Tam Jeanne Rubsam Steven Stylianos Vincent Duron 《Journal of pediatric surgery》2018,53(11):2202-2208
Background
Aggressive fluid resuscitative strategies have been the cornerstone of early trauma management for decades. However, recent prospective adult studies have challenged this practice, underlining the detrimental effect of positive fluid balance on cardiopulmonary function. Fluid overload has been associated with impaired oxygenation and morbidity in critically ill adults, but data is lacking in pediatric trauma patients.Methods
We completed a retrospective chart review of all pediatric trauma patients 0–18?years old admitted to a level 1 trauma center from January 2013 to December 2015. Four patient cohorts were established based on volume of fluid administered: < 20?ml/kg/day, 20–40?ml/kg/day, 40–60?ml/kg/day, and?>?60?ml/kg/day. The primary outcome was death. Secondary outcomes included the number of days on the ventilator, intensive care unit length of stay (ICU LOS), overall length of stay (LOS), number of days nil per os (NPO) as an indicator of ileus, and incidence of bloodstream infection and/or surgical site infection.Results
The mean volume of fluid administered over the first 24?h was 41?ml/kg/day, and 28?ml/kg/day over the first 48?h. ICU length of stay and overall length of stay were increased in patients who received more than 60?ml/kg/day in the first 24?h of their hospitalization. Furthermore, ventilator use, ICU length of stay, overall length of stay, and time to resumption of a regular diet were all increased in patients who received > 60?ml/kg/day over 48?h.Conclusions
Early administration of high volumes of crystalloid fluid greater than 60?ml/kg/day significantly correlates with pulmonary complications, days NPO, and hospital length of stay. These results span the first 48?h of a patient's hospital stay and should encourage surgical care providers to exercise judicious use of crystalloid fluid administration in the trauma bay, ICU, and floor.Type of Study
Therapeutic.Level of Evidence
Level III. 相似文献15.
16.
17.
Etienne St-Louis David Bracco James Hanley Tarek Razek Robert Baird 《Journal of pediatric surgery》2018,53(1):136-140
Background
There is a need for a pediatric trauma outcomes benchmarking model that is adapted for Low-and-Middle-Income Countries (LMICs). We used the National-Trauma-Data-Bank (NTDB) and applied constraints specific to resource-poor environments to develop and validate an LMIC-specific pediatric trauma score.Methods
We selected a sample of pediatric trauma patients aged 0–14 years in the NTDB from 2007 to 2012. Primary outcome was in-hospital death. Logistic regression was used to create the Pediatric Resuscitation and Trauma Outcome (PRESTO) score, which includes only low-tech predictor variables — those easily obtainable at point-of-care. Internal validation was performed using 10-fold cross-validation. External validation compared PRESTO to TRISS using ROC analyses.Results
Among 651,030 patients, there were 64% males. Median age was 7. In-hospital mortality-rate was 1.2%. Mean TRISS predicted mortality was 0.04% (range 0%–43%). Independent predictors included in PRESTO (p < 0.01) were age, blood pressure, neurologic status, need for supplemental oxygen, pulse, and oxygen saturation. The sensitivity and specificity of PRESTO were 95.7% and 94.0%. The resulting model had an AUC of 0.98 compared to 0.89 for TRISS.Conclusion
PRESTO satisfies the requirements of low-resource settings and is inherently adapted to children, allowing for benchmarking and eventual quality improvement initiatives. Further research is necessary for in-situ validation using prospectively collected LMIC data.Level of evidence
Level III — Case–Control (Prognostic) Study. 相似文献18.
Sana Rokhsefat Deanna E. Morra Martin Offringa Lisa M. Askie Lauren E. Kelly 《Journal of pediatric surgery》2018,53(7):1273-1279
Background
Prospective clinical trial registration serves to increase transparency and to mitigate selective reporting bias. An assessment of adult surgical trials revealed poor trial registration practice with incomplete provision of information in registries and inconsistent information in the corresponding publication. The extent and completeness of pediatric surgical trial registration are unknown. We aimed to determine the proportion and adequacy of clinical trial registration in pediatric surgery trials published in 2014.Methods
Using sensitive search strategies in MEDLINE, abstracts and full-texts of prospective pediatric intervention studies published in 2014 were screened in duplicate. Pediatric surgical trials were included. Clinical trial registration numbers obtained from publications were searched in trial registries. Data were extracted based on WHO 20-item minimum data set to determine the completeness of registration data. The proportion of registered trials was recorded and registration data were compared to reported data in the corresponding publication.Results
Our search and abstract screening identified 3375 articles for full text review. Following coding, a total of 54 pediatric surgical trials were included and analyzed; 28% (15/54) of which published a registration number. In trials which reported a registration number, 40% (6/15) were retrospectively registered and 40% (6/15) had made changes to their registered primary and/or secondary outcome measures. One included published trial reported an incorrect registration number.Conclusions
Analysis of pediatric surgery trials published in 2014 revealed a poor prospective trial registration rate and incomplete registration data. Our study supports future initiatives for improved registration behaviors in pediatric surgery trials to ensure high-quality, transparent, reproducible evidence is generated.Study type
Therapeutic (clinical trials), level II. 相似文献19.
Robert J. Vandewalle Julia K. Peceny Scott C. Dolejs Jodi L. Raymond Thomas M. Rouse 《Journal of pediatric surgery》2018,53(2):362-366
Purpose
The utility of measuring the pediatric adjusted shock index (SIPA) at admission for predicting severity of blunt injury in pediatric patients has been previously reported. However, the utility of following SIPA after admission is not well described.Methods
The trauma registry from a level-one pediatric trauma center was queried from January 1, 2010 to December 31, 2015. Patients were included if they were between 4 and 16 years old at the time of admission, sustained a blunt injury with an Injury Severity Score ≥ 15, and were admitted less than 12 h after their injury (n = 286). Each patient's SIPA was then calculated at 0, 12, 24, 36, and 48 h after admission and then categorized as elevated or normal at each time frame based upon previously reported values. Trends in outcome variables as a function of time from admission for patients with an abnormal SIPA to normalize as well as patients with a normal admission SIPA to abnormal were analyzed.Results
In patients with a normal SIPA at arrival, 18.4% of patients who developed an elevated SIPA at 12 h after admission died, whereas 2.4% of patients who maintained a normal SIPA throughout the first 48 h of admission died (p < 0.01). Among patients with an elevated SIPA at arrival, increased length of time to normalize SIPA correlated with increased length of stay (LOS) and intensive care unit (ICU) LOS. Similarly, elevation of SIPA after arrival in patients with a normal initial SIPA correlated to increased LOS and ICU LOS.Conclusions
Patients with a normal SIPA at time of arrival who then have an elevated SIPA in the first 24 h of admission are at increased risk for morbidity and mortality compared to those whose SIPA remains normal throughout the first 48 h of admission. Similarly, time to normalize an elevated admission SIPA appears to directly correlate with LOS, ICU LOS, and other markers of morbidity across a mixed blunt trauma population. Whether trending SIPA early in the hospital course serves only as a marker for injury severity or if it has utility as a resuscitation metric has not yet been determined.Type of study
Prognostic.Level of evidence
Level II. 相似文献20.
Lindsey B. Armstrong David P. Mooney Harriet Paltiel Carol Barnewolt Beatrice Dionigi Mary Arbuthnot Chinwendu Onwubiko Susan A. Connolly Delma Y. Jarrett Jill M. Zalieckas 《Journal of pediatric surgery》2018,53(3):548-552