儿科创伤潜力:以创伤中心资源利用为基础,努力实现更好的门
Caitlin J Crosier1, Amber Mehmood2, Keith Thatch1
1Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL 33701, USA.
Children (Basel, Switzerland)
|January 28, 2026
概括
国际疾病预防控制中心的临床护理严重性评分 (ICASS) 优于传统的伤害严重性评分 (ISS) 和国际疾病预防控制中心的伤害严重性评分 (ICISS),用于识别需要儿科创伤资源的儿童. 这表明ICASS可以改进儿科创伤系统中的undertriage定义.
科学领域:
- 创伤外科 手术 创伤外科
- 儿科重症监护 儿科重症监护
- 医疗保健服务研究 医疗服务研究
背景情况:
- 儿科创伤系统需要准确的指标来评估分拣决策,并识别未分拣,即受伤儿童没有得到适当的护理.
- 目前的低分量定义依赖于基于死亡率的得分,如受伤严重程度得分 (ISS) 和ICD受伤严重程度得分 (ICISS).
- 基于资源的指标,如ICD临床关怀严重性评分 (ICASS),可能为儿科低位评估提供更合适的方法.
研究的目的:
- 评估ISS,ICISS和ICASS之间的关系以及对儿科创伤资源 (NFPTCR) 的需求.
- 通过使用基于资源的指标,获得对儿科创伤的更实证的定义.
主要方法:
- 利用美国外科医生学院创伤质量改善计划数据库,针对15岁或更年轻的患者.
- 根据包括输血,侵入性手术,ICU入院/停留,通风和身体虐待儿童在内的标准定义NFPTCR.
- 使用多变量后勤回归和ROC分析评估了ISS,ICISS和ICASS的区分能力.
主要成果:
- 在97,773名儿童中,16%需要儿科创伤资源 (NFPTCR+).
- 与ISS (0.760) 和ICISS (0.701) 相比,ICASS在识别NFPTCR+患者方面表现优越 (曲线下的面积:0.812).
- 在识别NFPTCR+时,ICASS获得了高灵敏度 (分数为5的95%,分数为10的93%,分数为15的89%),其表现优于ISS.
结论:
- 在识别需要儿科创伤资源的儿童方面,ICASS指标比ISS和ICISS更有效.
- 应该考虑根据ICASS等资源利用指标重新定义儿科创伤底.
- 这种方法可能会导致更准确的识别和改善严重受伤儿童的护理.
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