儿科突发性损伤的可变管理:一个多中心的回顾性队列研究
Sindhu V Mannava1, Rodica Muraru, Jodi Raymond
1From the Department of Surgery (S.V.M.), and Department of Surgery (R.M.), Surgical Outcomes and Quality Improvement Center, Indiana University School of Medicine, Indianapolis, Indiana; Riley Hospital for Children (J.R.), Indiana University Health, Indianapolis, Indiana; Division of Pediatric Surgery, Department of Surgery (T.A.M., M.P.L.), Indiana University School of Medicine, Indianapolis, Indiana; Division of Pediatric Surgery (K.C.B., R.T.), Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio; Division of Pediatric Surgery (K.F.-O'.B., D.R.L., J.P.M.), Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Surgery (H.A.H., K.E.S., N.R.S.), University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Surgery (S.D.S.P., M.E.), Children's Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri; Division of Pediatric Surgery (S.A.A., J.B.P.), Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois; Department of Surgery (K.C.), University of Chicago Pritzker School of Medicine, Chicago, Illinois; Division of Pediatric Surgery (S.C., D.F., T.W.), Norton Children's Hospital, University of Louisville, Louisville, Kentucky; Division of Pediatric Surgery (S.D.G.), Ann and Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Nationwide Children's Hospital (S.K.), Columbus, Ohio; Division of Pediatric General and Thoracic Surgery (M.K.), Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Pediatric Surgery, Department of Surgery (C.L.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Division of Pediatric Surgery (G.Z.M.), Comer Children's Hospital, University of Chicago Pritzker School of Medicine, Chicago, Illinois; Division of Pediatric General and Thoracic Surgery (S.M.), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Surgery (N.M.S.), St. Louis School of Medicine, Washington University, St. Louis, Missouri; Department of Surgery (M.S.), School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; and Division of Pediatric Surgery (A.Y.), St. Louis School of Medicine, Washington University, St. Louis, Missouri.
儿科突性损伤的管理有很大差异,没有标准的指导方针. 这项研究发现,虽然孤立的伤害显示出极小的结果差异,但多创伤患者从重症监护室 (ICU) 的入院中受益.
科学领域:
- 儿科外科手术 儿科外科手术
- 创伤外科手术是什么
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 缺乏针对儿科突性损伤的综合管理指南.
- 护理可能存在显著的差异,影响患者的治疗结果.
- 本研究旨在描述当前的管理实践及其与不良事件的关联.
研究的目的:
- 描述儿科突性损伤的当代管理策略.
- 探索临床管理和不良结果之间的关联.
- 确定改善护理标准化的领域.
主要方法:
- 来自11个I级创伤中心的276名儿科不性损伤患者的回顾性审查 (2020-2022).
- 根据伤害等级 (低:1-3,高:4-5) 和类型 (孤立与多创伤) 的分类.
- 管理策略的分析 (床,导管,抗生素,ICU,咨询,实验室/成像) 和结果 (干预,死亡率,感染,再接收,高血压,DVT).
主要成果:
- 管理策略,如使用抗生素,ICU入院和尿道导管在各个机构中各不相同.
- 根据床上休息,抗生素或出院后成像,不良结果和干预结果没有显著差异.
- 接受ICU治疗的高度多创伤患者的不良结果 (55.6%) 比没有 (18.2%) 的患者要高得多.
- 低级多创伤患者有序列血红蛋白,实验室或住院成像,与没有的患者相比,结果更好.
结论:
- 儿童脏损伤的管理在各机构之间不一致.
- 孤立的损伤显示,尽管管理方式不同,结果的变化很小.
- 需要基于共识的算法来规范护理和改善结果,特别是对于多创伤患者.
相关概念视频
Acute Kidney Injury I: Introduction
Acute Kidney Injury II: Pathophysiology
Acute Kidney Injury III: Clinical Manifestations
Acute Kidney Injury IV: Diagnostic Studies and Prevention
Acute Kidney Injury V: Interprofessional Care
Acute Kidney Injury VI: Nursing Management


