生命标志切线的比较,以识别患有重大创伤的儿童
Jillian K Gorski1, Pradip P Chaudhari2, Ryan G Spurrier3
1Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA network open
|February 16, 2024
概括
从经验上获得的生命体征为识别主要儿科创伤提供了一个平衡的方法,改进了现有的高级创伤生命支持 (ATLS) 和儿科高级生命支持 (PALS) 标准. 这些新标准可以更好地识别患有严重结果高风险的儿童.
科学领域:
- 儿科创伤护理 儿童创伤护理
- 紧急医疗 紧急医疗
- 临床分类是临床分类.
背景情况:
- 生命体征对于评估受伤儿童在分拣期间至关重要.
- 目前的创伤评估协议,如高级创伤生命支持 (ATLS) 和儿科高级生命支持 (PALS),使用特定的生命体征标准.
研究的目的:
- 为了比较ATLS和PALS生命体征标准的有效性,与在儿科患者中识别重大创伤的经验性推导标准进行比较.
- 为了确定哪一套标准最能平衡儿科创伤分类中的敏感性和特异性.
主要方法:
- 使用2021年美国外科医生学院创伤质量改善计划 (TQIP) 数据进行的回顾性队列研究.
- 分析包括患有严重伤害的儿科患者 (<18岁),将初始生命体征 (心率,呼吸率,SBP) 与重大创伤结果进行比较.
- 使用接收器操作特征曲线评估性能,并根据2019年TQIP数据集进行验证.
主要成果:
- 经验性推导的标准显示灵敏度为80.0%,特异性为48.7%,超过ATLS标准 (54.5%灵敏度,72.9%特异性),表现与PALS标准 (88.4%灵敏度,25.1%特异性) 类似.
- 根据经验推导的标准,接收器运行特征曲线下的面积 (70.9%) 优于ATLS (65.4%) 和可比于PALS (69.6%).
- 对2019年数据集的验证证实了这些发现的一致性.
结论:
- 与ATLS标准相比,经验性推导的生命体征标准为识别主要儿科创伤提供了更高的敏感性和特异性的平衡.
- 这些发现表明,经验性推导的标准可以提高对患有创伤相关发病率和死亡率显著风险的儿童的识别.
- 该研究强调了通过数据驱动的生命体征评估来改善儿科创伤分拣的潜力.
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