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Pediatric Blunt Liver and Spleen Injury Treated in Hospitals With Pediatric Intensive Care Units: Post-hoc Analysis
Ryo Yamamoto1, Yukio Sato1, Katsuya Maeshima1
1Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.
Insights
Pediatric patients with blunt liver and spleen injury (BLSI) rarely experienced adverse events. Hospitals with pediatric intensive care units (PICUs) showed lower adjusted 30-day mortality for BLSI patients.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Critical Care Medicine
Background:
- Blunt liver and spleen injury (BLSI) is a significant concern in pediatric trauma.
- Evaluating outcomes in pediatric patients with BLSI is crucial for optimizing care.
- Understanding the impact of hospital resources, such as pediatric intensive care units (PICUs), is essential.
Purpose of the Study:
- To compare outcomes of pediatric patients with BLSI treated in hospitals with and without PICUs.
- To assess the impact of PICU availability on 30-day mortality and adverse events in pediatric BLSI.
- To determine if PICU admission influences the management and survival of pediatric BLSI patients.
Main Methods:
- A multicenter observational study analyzed data from 83 hospitals between 2008 and 2019.
- Pediatric patients (≤16 years) with BLSI were included.
- Thirty-day mortality and adverse events were compared between hospitals with and without PICUs, using inverse probability weighting for adjustments.
Main Results:
- Among 1401 patients, 30-day mortality was low overall (0.7% in hospitals with PICUs vs. 1.3% in hospitals without PICUs).
- Adjusted 30-day mortality was significantly lower in hospitals with PICUs compared to those with adult ICUs (OR 0.22).
- Adverse events were similar, except for fewer emergency hemostasis procedures for ruptured pseudoaneurysm in hospitals with PICUs.
Conclusions:
- Adverse events and 30-day mortality for pediatric BLSI are rare, irrespective of PICU availability.
- Treatment in hospitals with PICUs is associated with lower adjusted 30-day mortality for pediatric BLSI.
- PICU availability appears to be a beneficial factor in managing pediatric patients with blunt liver and spleen injuries.
Background:
We evaluated the outcomes of pediatric patients with blunt liver and spleen injury (BLSI) admitted to hospitals with pediatric intensive care units (PICUs).
Methods:
A post-hoc analysis of a multicenter observational study on pediatric patients (≤16 years) with BLSI at 83 hospitals between 2008 and 2019 was conducted. Thirty-day mortality and BLSI-associated adverse events were compared between patients treated in hospitals with and without PICUs. Estimated 30-day mortality was compared, adjusting for demographics, comorbidities, injury mechanism and severity, and resuscitative treatments using inverse probability weighting.
Results:
Among 1401 patients, 421 were treated in hospitals with PICUs and 207 were admitted to a PICU. The 30-day mortality was 3 (0.7 %) and 13 (1.3 %) in patients treated in hospitals with and without PICUs, respectively, and was comparable between the patients treated in PICUs and adult ICUs (1 [0.5 %] vs. 9 [1.9 %]). The adjusted 30-day mortality was lower in patients treated in hospitals with PICUs than in those treated in hospitals with adult ICUs (3 [0.2 %] vs. 13 [1.0 %]; odds ratio 0.22 [0.06-0.79]; p = 0.012) and in those treated in PICUs than in those treated in adult ICUs (2 [0.3 %] vs. 10 [1.5 %]; odds ratio 0.22 [0.05-0.98]; p = 0.041). BLSI-related adverse events were similar regardless of the PICU availability or admission, except for emergency hemostasis of ruptured pseudoaneurysm, which was fewer in patients treated in hospitals with PICUs.
Conclusions:
Adverse events, including 30-day mortality, were rare, regardless of PICU availability, and the adjusted 30-day mortality was lower in patients treated in PICUs.
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