Early vasopressor administration in pediatric blunt liver and spleen injury: An ATOMAC + study
| Autor: | David M. Notrica, Shawn D. St. Peter, Charles M. Leys, Amina Bhatia, Nilda M. Garcia, Jeremy J. Johnson, Adam C. Alder, Lois W Sayrs, R. Todd Maxson, Todd A. Ponsky, Cynthia Greenwell, Jessica A. Naiditch, James W. Eubanks, Bethany L Sussman, Karla A. Lawson, Daniel J. Ostlie |
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| Rok vydání: | 2021 |
| Předmět: |
endocrine system
medicine.medical_specialty Wounds Nonpenetrating 03 medical and health sciences 0302 clinical medicine Blunt Trauma Centers 030225 pediatrics Epidemiology Humans Medicine Prospective Studies Child Prospective cohort study Retrospective Studies business.industry General Medicine Emergency department medicine.disease Liver Spleen injury Blunt trauma 030220 oncology & carcinogenesis Anesthesia Pediatrics Perinatology and Child Health Propensity score matching Surgery business Spleen hormones hormone substitutes and hormone antagonists Pediatric trauma |
| Zdroj: | Journal of Pediatric Surgery. 56:500-505 |
| ISSN: | 0022-3468 |
| DOI: | 10.1016/j.jpedsurg.2020.07.007 |
| Popis: | No prior studies have examined the outcomes of early vasopressor use in children sustaining blunt liver or spleen injury (BLSI).A planned secondary analysis of vasopressor use from a 10-center, prospective study of 1004 children with BLSI. Inverse probability of treatment weighting (IPTW) was used to compare patients given vasopressors48 h after injury to controls based on pretreatment factors. A logistic regression was utilized to assess survival associated with vasopressor initiation factors on mortality and nonoperative management (NOM) failure.Of 1004 patients with BLSI, 128 patients were hypotensive in the Pediatric Trauma Center Emergency Department (ED); 65 total patients received vasopressors. Hypotension treated with vasopressors was associated with a sevenfold increase in mortality (AOR = 7.6 [p 0.01]). When excluding patients first given vasopressors for cardiac arrest, the risk of mortality increased to 11-fold (AOR = 11.4 [p = 0.01]). All deaths in patients receiving vasopressors occurred when started within the first 12 h after injury. Vasopressor administration at any time was not associated with NOM failure.After propensity matching, early vasopressor use for hypotension in the ED was associated with an increased risk of death, but did not increase the risk of failure of NOM.Level III prognostic and epidemiological, prospective. |
| Databáze: | OpenAIRE |
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