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Utilizing Near-Infrared Spectroscopy to Identify Pediatric Trauma Patients Needing Lifesaving Interventions: A
David W Ashby1, Binod Balakrishnan2, David M Gourlay2
1From the Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Insights
Near-infrared spectroscopy (NIRS) can help identify children needing lifesaving interventions (LSIs) in trauma care. A somatic NIRS value below 70% in pediatric trauma patients significantly increases the odds of requiring an LSI.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Medical Technology
Background:
- Pediatric trauma patients require rapid identification of those needing lifesaving interventions (LSIs).
- Near-infrared spectroscopy (NIRS) is a non-invasive monitoring tool with potential applications in trauma assessment.
Purpose of the Study:
- To prospectively evaluate the utility of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs).
Main Methods:
- A prospective cohort study included 148 pediatric trauma patients (0-18 years) requiring trauma team response.
- The relationship between lowest somatic NIRS saturation and the need for LSIs was analyzed.
- Statistical analysis included chi-squared and Student t tests.
Main Results:
- 43.9% of patients had a somatic NIRS value <70%.
- Pediatric trauma patients with somatic NIRS <70% had significantly increased odds of requiring an LSI (OR, 2.11).
- Somatic NIRS values <70% demonstrated 56% sensitivity and 63% specificity for LSI prediction.
Conclusions:
- Somatic NIRS values <70% within 30 minutes of emergency department arrival indicate an increased likelihood of requiring LSIs in pediatric trauma patients.
- Thoracostomy was a significant lifesaving procedure identified.
- Further multicenter studies are warranted to assess NIRS's role in improving identification of critically injured children.
Objectives:
The aim of this study was to prospectively investigate the role of near-infrared spectroscopy (NIRS) in identifying pediatric trauma patients who required lifesaving interventions (LSIs).
Methods:
Prospective cohort study of children age 0 to 18 years who activated the trauma team response between August 15, 2017, and February 12, 2019, at a large, urban pediatric emergency department (ED).The relationship between the lowest somatic NIRS saturation and the need for LSIs (based on published consensus definition) was investigated. Categorical variables were analyzed by χ 2 test, and continuous variables were analyzed by Student t test.
Results:
A total of 148 pediatric trauma patients had somatic NIRS monitoring and met the inclusion criteria. Overall, 65.5% were male with a mean ± SD age of 10.9 ± 6.0 years. Injuries included 67.6% blunt trauma and 28.4% penetrating trauma with mortality of 3.4% (n = 5). Overall, the median lowest somatic NIRS value was 72% (interquartile range, 58%-88%; range, 15%-95%), and 43.9% of patients had a somatic NIRS value <70%. The median somatic NIRS duration recorded was 11 minutes (interquartile range, 7-17 minutes; range, 1-105 minutes). Overall, 36.5% of patients required a LSI including 53 who required a lifesaving procedure, 17 required blood products, and 17 required vasopressors. Among procedures, requiring a thoracostomy was significant.Pediatric trauma patients with a somatic NIRS value <70% had a significantly increased odds of requiring a LSI (odds ratio, 2.11; 95% confidence interval, 1.07-4.20). Somatic NIRS values <70% had a sensitivity and specificity of 56% and 63%, respectively.
Conclusions:
Pediatric trauma patients with somatic NIRS values <70% within 30 minutes of ED arrival have an increased odds of requiring LSIs. Among LSIs, pediatric trauma patients requiring thoracostomy was significant. The role of NIRS in incrementally improving the identification of critically injured children in the ED and prehospital setting should be evaluated in larger prospective multicenter studies.
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