儿科出血性休克中的生存偏差:我们是否误解了数据?
Travis M Sullivan1, Genevieve J Sippel, Waverly V Gestrich-Thompson
1From the Division of Trauma and Burn Surgery (T.M.S., G.J.S., W.V.G.-T., R.S.B.), Children's National Hospital, Washington, DC; Department of Surgery (A.R.J.), University of California San Francisco; and Division of Pediatric Surgery (A.R.J.), UCSF Benioff Children's Hospitals, San Francisco, CA.
The journal of trauma and acute care surgery
|September 27, 2023
概括
仅仅输血数据可能会低估儿科创伤因出血而导致的死亡. 生存偏差影响了多达11%的儿童伤害死亡,强调了在儿科创伤护理中更好地识别出血性休克的必要性.
科学领域:
- 创伤外科 手术 创伤外科
- 儿科重症监护中心儿童重症监护中心
- 流行病学 流行病学
背景情况:
- 流血是儿童创伤死亡的主要原因.
- 输血经常被用作严重出血的替代品.
- 这种方法可能会错误地分类输血前死亡的患者,引入生存偏差.
研究的目的:
- 用输血作为替代品评估儿科创伤死亡中的生存偏差.
- 估计死于受伤的儿童和青少年中这种偏差的患病率.
主要方法:
- 对2017-2020创伤质量改善计划数据库的回顾性分析.
- 包括因受伤而死亡的儿科患者 (<18岁).
- 多变量逻辑回归用于评估死亡时间和输血之间的关联,控制共变量.
主要成果:
- 分析了6063例儿童受伤死亡病例.
- 在15分钟内死亡的儿童接受输血的几率明显降低 (OR0.1).
- 生存偏差可能影响多达11%的儿科创伤死亡,低估了出血性休克.
结论:
- 仅仅输血的发生不足以定义儿科创伤中的早期出血性休克.
- 为了准确识别不受控制的出血,需要额外的临床变量.
- 对于儿科创伤复苏,需要改进诊断标准.
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