Prehospital Reverse Shock Index Times Glasgow Coma Scale as a Predictor for Trauma Intervention in Paediatric Trauma Patients.

IF 2.4 2区 医学 Q1 PEDIATRICS Journal of pediatric surgery Pub Date : 2024-10-21 DOI:10.1016/j.jpedsurg.2024.162018
Nicholas J Dante, Ryan J Salvatore, Nicolas L Carayannopoulos, Sathyaprasad C Burjonrappa
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Abstract

Background: Previous studies have identified the reverse shock index x Glasgow Coma Scale (rSIG) as a tool for predicting the need for trauma intervention in pediatric patients. This study sought to investigate the utility of prehospital rSIG as a triage tool to predict the need for trauma-center level of care in a large pediatric cohort.

Methods: Data from the American College of Surgeons National Trauma Data Bank (NTDB) (2018-2020) were used. Patients aged 1-18 with valid values for prehospital systolic blood pressure (EMS SBP), prehospital heart rate (EMS HR), and EMS total GCS, were included. Prehospital rSIG was calculated as (EMS SBP/EMS HR) x EMS total GCS. Abnormal values for rSIG were defined as: ≤13.1, ≤16.5, and ≤20.1 for patients aged 1-6, 7-12, and 13-18, respectively. Injury severity was determined by Injury Severity Score (ISS). ISS 1-8 represented minor injury, 9-15 moderate injury, and 16 severe injury. Rates of hemorrhage control surgery, embolization, transfusion at 4 hours, mechanical ventilation, ICU stay 3 days, and mortality was compared between patients with abnormal vs. normal prehospital rSIG.

Results: 120,941 patients were included in the analysis; 60269 (49.8 %) had an abnormal prehospital rSIG. Patients with abnormal prehospital rSIG had significantly higher rates of 1 trauma intervention (23.3 % vs 8.3 %, p < 0.0001) and mortality (2.7 % vs 0.1 %, p < 0.0001). When stratified by injury severity, rates of 1 trauma intervention were significantly higher for patients with abnormal prehospital rSIG in minor (2.8 % vs. 1.5 %, p < 0.0001), moderate (18.9 % vs 10.5 %, p < 0.0001), and severe injury (69.8 % vs 43.1 %).

Conclusion: Prehospital rSIG appears to be an independent predictor of both trauma intervention and mortality, regardless of injury severity, in the pediatric trauma population. Use of prehospital rSIG may prove useful in triage situations, particularly mass casualty incidents, to determine need for trauma-center care.

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院前反向休克指数时代格拉斯哥昏迷量表作为儿科创伤患者创伤干预的预测指标。
背景:先前的研究发现,反向休克指数 x 格拉斯哥昏迷量表(rSIG)是预测儿科患者是否需要创伤干预的工具。本研究旨在调查院前反向休克指数作为分诊工具的实用性,以预测大量儿科患者是否需要接受创伤中心级别的治疗:研究使用了美国外科学院国家创伤数据库(NTDB)(2018-2020年)的数据。纳入了院前收缩压(EMS SBP)、院前心率(EMS HR)和EMS总GCS有效值的1-18岁患者。院前 rSIG 的计算公式为 (EMS SBP/EMS HR) x EMS 总 GCS。1-6 岁、7-12 岁和 13-18 岁患者的 rSIG 异常值分别定义为:≤13.1、≤16.5 和≤20.1。受伤严重程度由受伤严重程度评分(ISS)决定。ISS 1-8 代表轻伤,9-15 代表中伤,16 代表重伤。比较了院前 rSIG 异常与正常患者的出血控制手术率、栓塞率、4 小时输血率、机械通气率、重症监护室住院 3 天率和死亡率:分析共纳入 120941 例患者,其中 60269 例(49.8%)院前 rSIG 异常。院前 rSIG 异常的患者接受 1 次创伤干预的比例明显更高(23.3% 对 8.3%,P 结论:院前 rSIG 异常的患者接受 1 次创伤干预的比例明显更高:院前 rSIG 似乎是儿科创伤人群中创伤干预和死亡率的独立预测因素,与受伤严重程度无关。院前 rSIG 可用于分流,尤其是大规模伤亡事件,以确定是否需要创伤中心护理。
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来源期刊
CiteScore
1.10
自引率
12.50%
发文量
569
审稿时长
38 days
期刊介绍: The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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