背景:虐待性颅脑损伤(AHT)是小儿创伤性脑损伤(TBI)的一种机制,具有高发病率和死亡率。多器官功能障碍综合征(MODS),定义为两个或多个器官系统的器官功能障碍,也与危重儿童的发病率和死亡率有关。我们的目的是比较MODS的频率,并评估其与AHT和意外TBI(aTBI)之间的关系。
方法:这是一个单一的中心,回顾性队列研究包括2014年至2021年期间入住儿科重症监护病房的3岁以下非穿透性TBI儿童.出院(HD)时,使用儿科Logistic器官功能障碍2评分和新的损伤状态(与受伤前相比,功能状态量表评分变化>1),在第1、3和7天存在或不存在MODS,短期时间点,从电子健康记录中提取长期时间点。进行多元逻辑回归以检查MODS和TBI机制与新的损害状态之间的关联。
结果:在576名儿童中,215(37%)患有AHT,361(63%)患有aTBI。更多患有AHT的儿童在第1天患有MODS(34%vs.23%,p=0.003),3(28%与6%,p<0.001),和7(17%与3%,p<0.001)与aTBI相比。最常见的器官衰竭是心血管([AHT]66%vs.[aTBI]66%,p=0.997),神经系统(33%vs.16%,p<0.001),和呼吸(34%vs.15%,p<0.001)。MODS与HD的多变量逻辑回归中的新损伤相关(比值比19.1[95%置信区间9.8-38.6,p<0.001]),短期放电(7.4[3.7-15.2,p<0.001]),和长期放电(4.3[2.0-9.4,p<0.001])]。AHT还与HD的新损伤相关(3.4[1.6-7.3,p=0.001]),短期放电(2.5[1.3-4.7,p=0.005]),和长期放电(2.1[1.1-4.1,p=0.036])。
结论:作为一种机制的虐待性头部创伤与TBI后的MODS有关。AHT机制和MODS均与所有时间点的新损伤相关。
BACKGROUND: Abusive head trauma (AHT) is a mechanism of pediatric traumatic brain injury (TBI) with high morbidity and mortality. Multiorgan dysfunction syndrome (MODS), defined as organ dysfunction in two or more organ systems, is also associated with morbidity and mortality in critically ill children. Our objective was to compare the frequency of MODS and evaluate its association with outcome between AHT and accidental TBI (aTBI).
METHODS: This was a single center, retrospective cohort study including children under 3 years old admitted to the pediatric intensive care unit with nonpenetrating TBI between 2014 and 2021. Presence or absence of MODS on days 1, 3, and 7 using the Pediatric Logistic Organ Dysfunction-2 score and new impairment status (Functional Status Scale score change > 1 compared with preinjury) at hospital discharge (HD), short-term timepoint, and long-term timepoint were abstracted from the electronic health record. Multiple logistic regression was performed to examine the association between MODS and TBI mechanism with new impairment status.
RESULTS: Among 576 children, 215 (37%) had AHT and 361 (63%) had aTBI. More children with AHT had MODS on days 1 (34% vs. 23%, p = 0.003), 3 (28% vs. 6%, p < 0.001), and 7 (17% vs. 3%, p < 0.001) compared with those with aTBI. The most common organ failures were cardiovascular ([AHT] 66% vs. [aTBI] 66%, p = 0.997), neurologic (33% vs. 16%, p < 0.001), and respiratory (34% vs. 15%, p < 0.001). MODS was associated with new impairment in multivariable logistic regression at HD (odds ratio 19.1 [95% confidence interval 9.8-38.6, p < 0.001]), short-term discharge (7.4 [3.7-15.2, p < 0.001]), and long-term discharge (4.3 [2.0-9.4, p < 0.001])]. AHT was also associated with new impairment at HD (3.4 [1.6-7.3, p = 0.001]), short-term discharge (2.5 [1.3-4.7, p = 0.005]), and long-term discharge (2.1 [1.1-4.1, p = 0.036]).
CONCLUSIONS: Abusive head trauma as a mechanism was associated with MODS following TBI. Both AHT mechanism and MODS were associated with new impairment at all time points.