背景:在2000年代初期,据报道,儿童钝性脾损伤(BSI)患者的治疗存在显著差异.这项研究的目的是评估不同类型创伤中心之间的最新趋势和差异。我们假设尽管脾切除术率呈下降趋势,但仍存在持续差异。
方法:这是一项使用美国外科医师学会创伤质量改善计划数据库的回顾性队列研究。我们纳入了2014年至2021年之间具有高级别BSI(缩写损伤量表3-5)的患者(年龄≤18岁)。根据创伤中心类型将患者分为三组(成人创伤中心[ATCs],混合创伤中心[MTC],和儿科创伤中心[PTC])。主要结果是脾切除术率。进行Logistic回归以评估创伤中心类型与临床结局之间的关联。此外,ATC脾切除术率的趋势,MTC,和PTC进行了评估。
结果:共有6601名高级别BSI患者被纳入分析。总的脾切除术率为524(17.5%),448(16.3%),空管中32人(3.7%),MTC,和PTC集团,分别。与PTC相比,ATC和MTC的脾切除术率明显更高(ATC:OR=5.72,95CI=3.78-8.67,p<0.001,MTC:OR=4.50,95CI=2.97-6.81,p<0.001),在ATC和MTC中观察到脾切除术率下降的趋势(ATC:OR=0.92,95CI=0.87-0.97,p=0.003,MTC:OR=0.92,95CI=0.87-0.98,p=0.013).
结论:这项研究表明,不同类型的创伤中心在处理患有高级别BSI的儿童方面存在持续的差异。
In the early 2000s, substantial variations were reported in the management of pediatric patients with blunt splenic injury (BSI). The purpose of this study was to assess the recent trends and disparities between different types of trauma centers. We hypothesized that there would be persistent disparities despite decreased trends in the rate of splenectomy.
This is a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program database. We included patients (age ≤18 years) with high-grade BSI (Abbreviated Injury Scale 3-5) between 2014 and 2021. The patients were divided into three groups based on trauma center types (adult trauma centers [ATCs], mixed trauma centers [MTCs], and pediatric trauma centers [PTCs]). The primary outcome was the splenectomy rate. Logistic regression was performed to evaluate the association between trauma center types and clinical outcomes. Additionally, the trends in the rate of splenectomy at ATCs, MTCs, and PTCs were evaluated.
A total of 6601 patients with high-grade BSI were included in the analysis. Overall splenectomy rates were 524 (17.5%), 448 (16.3%), and 32 (3.7%) in the ATC, MTC, and PTC groups, respectively. ATCs and MTCs had significantly higher splenectomy rates compared to PTCs (ATCs: OR = 5.72, 95%CI = 3.78-8.67, and p < 0.001 and MTCs: OR = 4.50, 95%CI = 2.97-6.81, and p < 0.001), while decreased trends in the splenectomy rates were observed in ATCs and MTCs (ATCs: OR = 0.92, 95%CI = 0.87-0.97, and p = 0.003 and MTCs: OR = 0.92, 95%CI = 0.87-0.98, and p = 0.013).
This study suggested persistent disparities between different trauma center types in the management of children with high-grade BSI.