■尽管胫骨近端是儿科患者骨内(IO)线放置的常见部位,先前发表的数据表明,在该位置,婴儿和儿童的错位率很高。尽管股骨远端IO线的流速通常高于胫骨近端,到目前为止,目前尚未发表评估儿科患者股骨远端IO入路的研究.因此,我们的目的是比较院前设置中胫骨近端和股骨远端之间的儿科IO线插入尝试的成功率.
我们对院前儿科患者进行了回顾性图表审查,这些患者在2015年5月至2024年1月期间接受了棕榈滩县消防救援的至少一次IO线放置尝试。我们排除了缺少IO尝试位置特定文档的记录。我们比较了股骨远端和胫骨近端的未调整成功率,我们还比较了倾向评分匹配和多变量逻辑回归后的成功率.其次,我们评估了各解剖部位IO管路的院前并发症发生率.
■我们确定了163名尝试IO并符合分析条件的儿科患者。中位年龄为1.9岁(IQR:0.46至4.2岁)。在这163名患者中,有234次尝试血管通路,包括股骨远端82次IO尝试和胫骨近端72次IO尝试。股骨远端尝试的未调整成功率为89.0%,与胫骨近端尝试的84.7%相比,差异为4.3%(95%CI-6.4至15.0%)。在倾向得分匹配后,我们发现调整后的优势比为2.0(95%CI为0.66至6.8),有利于股骨远端成功放置。股骨远端(5.5%)和胫骨近端(4.9%)的院前并发症发生率相似。
■这项在院前环境中对儿科患者的回顾性分析表明,与胫骨近端相比,在股骨远端放置IO线的成功率可能略高。尽管没有达到统计意义,这些发现支持考虑将股骨远端作为儿科人群IO放置的可行选择.
UNASSIGNED: Although the proximal tibia is a common site for intraosseous (IO) line placement in pediatric patients, previously published data indicate high malposition rates in infants and children at this location. Although distal femur IO lines generally demonstrate higher flow rates than those at the proximal tibia, to date, there have been no published studies assessing distal femur IO access in pediatric patients. Thus, we aimed to compare the
success rates of pediatric IO line insertion attempts between the proximal tibia and the distal femur in a prehospital setting.
UNASSIGNED: We conducted a retrospective chart review of prehospital pediatric patients who underwent at least one IO line placement attempt by Palm Beach County Fire Rescue from May 2015 to January 2024. We excluded records lacking specific documentation of IO attempt location. We compared the unadjusted
success rates of distal femur to proximal tibia, and we also compared
success rates after propensity score matching and multivariable logistic regression. Secondarily, we assessed the prehospital complication rate of the IO lines at each anatomical site.
UNASSIGNED: We identified 163 pediatric patients who had an IO attempt and were eligible for analysis. Median age was 1.9 years (IQR: 0.46 to 4.2 years). Among those 163 patients, there were 234 vascular access attempts, including 82 IO attempts at the distal femur and 72 at the proximal tibia. The unadjusted
success rate of distal femur attempts was 89.0%, compared to 84.7% for proximal tibia attempts, a difference of 4.3% (95% CI -6.4 to 15.0%). After propensity score matching, we found an adjusted odds ratio of 2.0 (95% CI 0.66 to 6.8), favoring the distal femur for successful placement. Prehospital complication rates were similar for distal femur (5.5%) and proximal tibia (4.9%).
UNASSIGNED: This retrospective analysis of pediatric patients in a prehospital setting suggests that IO line placement at the distal femur might offer a marginally higher
success rate compared to the proximal tibia. Despite not reaching statistical significance, these findings support the consideration of distal femur as a viable option for IO placement in the pediatric population.