Identification of severely injured children at very low risk of emergent surgery: A national trauma registry study.

Autor: Gimelraikh Y; Emergency Department, Shaare Zedek Medical Center, Jerusalem, Israel; Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel., Epstein D; Critical Care Division, Rambam Health Care Campus, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion IT, Haifa, Israel. Electronic address: danyep@gmail.com., Radomislensky I; The National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel., Lipsky AM; The Ruth and Bruce Rappaport Faculty of Medicine, Technion IT, Haifa, Israel; Emergency Department, Emek Medical Center, Afula, Israel., Givon A; The National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel., Berant R; Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel., Berzon B; Emergency Department, Samson Assuta Hospital, Ashdod, Israel., Raz A; The Ruth and Bruce Rappaport Faculty of Medicine, Technion IT, Haifa, Israel; Anesthesiology Division, Rambam Health Care Campus, Haifa, Israel., Ben-Eli D; Major Trauma Service, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, Melbourne, Australia., Bodas M; The National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel., Samuel N; Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Major Trauma Service, The Alfred Hospital, Melbourne, Australia; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Sep; Vol. 55 (9), pp. 111678. Date of Electronic Publication: 2024 Jun 15.
DOI: 10.1016/j.injury.2024.111678
Abstrakt: Objective: The number of pediatric trauma patients requiring surgical interventions has been steadily decreasing allowing for a judicious approach to immediately available resources. This study aimed to derive and validate a prediction rule that reliably identifies injured children who are at very low risk for requiring emergency surgery upon emergency department (ED) arrival.
Methods: A retrospective cohort study of data included in the Israeli National Trauma Registry from January 1, 2011, through December 31, 2020, was conducted. We included children aged 0-14 years who presented to EDs from the scene of injury and were hospitalized. We excluded patients transferred between facilities or with isolated burns. The primary outcome was emergency operative intervention (EOI) performed within one hour of ED arrival. We tested mechanism, GCS, heart rate, and blood pressure as candidate predictors. We then randomized patients to two cohorts, derived and internally validated a prediction rule.
Results: During the study period, 83,859 children met enrollment criteria. The median age was 6 years (IQR 2-10) and 56,867 (67.8 %) were male; 75,450 (90.0 %) sustained blunt trauma. One hundred sixty-nine (0.20 %) children underwent EOI. In the derivation and validation cohorts, 34,138 (81.4 %) and 34,271 (81.7 %) patients, were classified as low risk based on blunt trauma mechanism, normal GCS (15), and low-risk heart rate (according to age). Of those, 8 (0.02 %) and 13 (0.04 %) required an EOI, respectively. In the validation cohort, the prediction rule for EOI had a sensitivity of 84 % (95 % CI 75-91), a specificity of 82 % (95 % CI 81-82), and a negative predictive value of 99.96 % (95 % CI 99.94-99.98). Among children with an Injury Severity Score>15, the sensitivity was 87 % (95 % CI 77-94), the specificity of 57 % (95 % CI 54-59), and the negative predictive value was 98.97 % (95 % CI 98.13-99.44).
Conclusions: A limited set of physiologic parameters, readily available at hospital admission can effectively identify injured children at very low risk for emergent surgery. For these children, immediate deployment of surgical resources may not be necessary.
Competing Interests: Declaration of competing interest Yulia GIMELRAIKH, Danny EPSTEIN, Irina RADOMISLENSKY, Ari M. LIPSKY, Adi GIVON, Ron BERANT, Baruch BERZON, Danny BEN-ELI, Moran BODAS, and Nir SAMUEL declare that they have no conflict of interest. Aeyal RAZ reports receiving consultant fees and research support from Medtronic and consultant fees from Neuroindex (none related to this work). This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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