儿童多创伤流行病学,急性诊断评估和治疗
Monica Christine Ciorba1, Marc Maegele
1Department of Orthopedics, Trauma Surgery and Sports Traumatology, Cologne-Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany; Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Campus, Cologne, Germany.
Deutsches Arzteblatt international
|March 12, 2024
概括
儿童多创伤管理需要专门的护理,因为解剖学和生理学的差异. 目前的指导方针强调了针对严重受伤儿童的气道控制,诊断和凝血管理的特定年龄协议.
科学领域:
- 儿科急救医学 儿科急救医学
- 创伤外科 手术 创伤外科
- 儿科重症监护 儿科重症监护
背景情况:
- 缺乏足够的临床经验导致儿童急性多创伤护理的不确定性.
- 儿科多创伤管理由于与成人的解剖学和生理学差异存在独特的挑战.
- 目前对儿科多创伤的证据有限,依赖于共识和成年人指南的修改.
研究的目的:
- 审查严重受伤的多创伤儿童急性护理的关键方面.
- 提供有关气道控制,体积和凝血管理,诊断成像和凝血研究的见解.
- 将急性护理实践与儿科多创伤的当前指导方针和文献保持一致.
主要方法:
- 在PubMed,Medline,Cochrane中央注册表和Epistemonikos (2001年1月至2023年8月) 进行选择性文献搜索.
- 包括综述文章和关于儿科多创伤管理的最新S2k临床实践指南.
- 综合与诊断评估和治疗策略相关的发现.
主要成果:
- 创伤性脑损伤 (66%) 和出血性休克 (17%) 是常见的,影响结果.
- 凝血病 (22%) 显著增加了儿科多创伤的死亡风险.
- 特定于年龄的ABCDE算法,低剂量CT协议 (PECARN标准) 和护理点凝血测试至关重要.
- 建议在儿科创伤参考中心进行治疗.
结论:
- 由于证据有限和儿科特定需求,儿童多创伤管理具有挑战性.
- 建议是基于共识,适应成人协议的儿童的独特特征.
- 标准化,适合年龄的方案对于改善严重受伤儿童的治疗结果至关重要.
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