巴西小儿脾损伤脾切除术的频率:回顾性分析。

IF 7 Q1 HEALTH CARE SCIENCES & SERVICES Lancet Regional Health-Americas Pub Date : 2024-07-28 eCollection Date: 2024-08-01 DOI:10.1016/j.lana.2024.100844
Luiza Telles, Ayla Gerk, Madeleine Carroll, Matheus Daniel Faleiro, Thais Barbosa de Oliveira, Abbie Naus, Roseanne Ferreira, Fabio Botelho, Joaquim Bustorff-Silva, David P Mooney, Julia Ferreira
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引用次数: 0

摘要

背景:在高收入国家,小儿钝性脾损伤的非手术治疗方法已得到广泛认可,这导致血流动力学稳定的儿童脾切除率较低。脾切除率已成为美国外科学院创伤委员会验证创伤中心的一项质量指标。然而,巴西等不同收入水平国家的儿童脾切除率数据仍然有限。本研究旨在评估过去十年中巴西儿童的创伤后脾脏切除率以及与当地资源的关系:从 FioCruz 数据库中获取了 2008 年至 2019 年小儿脾损伤和脾切除术的数据,包括患者年龄和入院服务(成人或小儿)。儿科外科医生、儿科重症监护室(PICU)床位和计算机断层扫描仪的地区数量来自巴西国家数据库。按入院年份和服务对全国脾脏切除率进行了分析,并按地区资源水平、儿科外科医生数量、儿科重症监护室床位数和计算机断层扫描机数对脾脏切除率进行了分析:共有 4061 名儿童因脾脏损伤住院,其中 2287 名(51.8%)儿童接受了脾脏切除术,这一比例随着时间的推移没有变化。76.8%的脾损伤患者为男性,23.1%为女性。平均年龄为 11.61 岁。与儿科相比,成人外科收治的儿科患者接受脾脏切除术的几率要高出 14.77 倍(OR = 14.77,95% CI 11.75-18.56,P 解释:巴西儿童创伤后脾脏切除率很高,远远超过高收入国家。地区儿科资源的增加与脾切除率的下降并不相称。要了解巴西在采用非手术疗法治疗小儿脾脏损伤方面存在的障碍,必须开展进一步的研究:本研究未从公共、商业或非营利部门的任何资助机构获得特定资助。
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Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis.

Background: Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.

Methods: Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.

Findings: 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.

Interpretation: The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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期刊介绍: The Lancet Regional Health – Americas, an open-access journal, contributes to The Lancet's global initiative by focusing on health-care quality and access in the Americas. It aims to advance clinical practice and health policy in the region, promoting better health outcomes. The journal publishes high-quality original research advocating change or shedding light on clinical practice and health policy. It welcomes submissions on various regional health topics, including infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, emergency care, health policy, and health equity.
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