■小儿钝性脾损伤的非手术治疗在高收入国家已经确立,导致血液动力学稳定的儿童脾切除术率低。脾切除术率成为美国外科医师学会创伤委员会使用的创伤中心验证的质量指标。然而,不同收入水平国家儿童脾切除术率的数据,比如巴西,保持有限。这项研究旨在评估过去十年巴西儿童的创伤后脾切除术率以及与当地资源的关系。
■2008年至2019年小儿脾损伤和脾切除术的数据,包括患者年龄和入院服务(成人或儿科),是从FioCruz数据库获得的,一个公众,免费,基于云的平台,提供广泛的国家健康数据。儿科外科医生的地区数量,儿科重症监护病房(PICU)病床,和计算机断层扫描扫描仪是从巴西国家数据库获得的。按年度和入院服务的全国脾切除术率分析和按地区资源水平的脾切除术率分析,儿科外科医生的数量,PICU病床,并进行了计算机断层扫描。
■4061名儿童因脾损伤住院,其中2287人(51.8%)接受了脾切除术,随着时间的推移不变。脾损伤患者男性占76.8%,女性占23.1%。平均年龄11.61岁。接受成人手术治疗的儿科患者的脾切除几率是儿科患者的14.77倍(OR=14.77,95%CI11.75-18.56,p<0.0001)。儿科外科医生的整体增加,PICU病床,CT扫描仪的可用性与脾切除术率的变化不一致。
■巴西儿童创伤后脾切除术率高,远远超过高收入国家。区域儿科资源的增加与脾切除术率的下降无关。进一步的研究对于了解巴西采用非手术治疗小儿脾损伤的障碍至关重要。
■这项研究没有获得任何公开资助机构的资助,商业,或非营利部门。
UNASSIGNED: Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.
UNASSIGNED: Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.
UNASSIGNED: 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.
UNASSIGNED: The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil\'s barriers to adopting non-operative management for pediatric splenic injuries.
UNASSIGNED: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.