分离游离液在儿童创伤患者中的意义

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-04-07 DOI:10.1016/j.jpedsurg.2025.162328

Robert Nelson, Stephanie Carmichael, Susan Taylor, Kristopher Lewis

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引用次数: 0

摘要

目的：小儿外伤患者分离游离液的影像学表现尚不明确。该研究的目的是通过回顾性队列研究，确定分离游离液的区别特征，以确定哪些特征适合保守治疗，而哪些特征与放射学上隐匿性损伤有关。我们假设，如果通过CT评估，游离腹内液体在儿科创伤患者中被确定为孤立的发现，那么更大的液体体积、更多解剖空间的液体和更复杂的液体可能表明更有可能需要手术干预。材料与方法回顾性队列研究了2007 - 2020年间100例有CT分离游离液证据的儿童创伤患者。Philips肿瘤追踪仪测定液体体积和密度。将患者分为两组：无术中损伤证据组（n = 93）和有术中损伤证据组（n = 7）。比较两组间的液量、密度和液袋。结果两组患者的液量、密度、液袋数差异均有统计学意义(p <；0.05)。非损伤组平均液量为4±6 mL，损伤组平均液量为31±29 mL。未损伤患者最高密度为13±10 HU，损伤患者最高密度为40±12 HU。具体来说，5 mL的临界值具有100%阴性预测值。96%的未受伤患者仅在一个部位有游离液体，而85%的受伤患者在多个部位有游离液体。所有受伤的病人在骨盆外或骨盆外都有积液袋。此外，仅在受伤患者中发现中枢性肠系膜积液。结论：儿童男性或经前女性患者盆腔内体积小、单纯性液体不应引起潜在损伤的关注，即使在创伤环境中也是如此。研究类型：回顾性队列研究。证据等级：III级。

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Implications of Isolated Free Fluid in Pediatric Trauma Patients

Purpose

The imaging finding of isolated free fluid in pediatric trauma patients is of unclear clinical significance. The study's purpose was to identify discriminatory features of isolated free fluid to determine which characteristics justify conservative management versus those concerning for radiologically occult injury, using a retrospective cohort study. We hypothesize that if free intraabdominal fluid is identified as an isolated finding in pediatric trauma patients by CT evaluation, then higher volume of fluid, fluid in more anatomic spaces, and more complex fluid may indicate a higher likelihood of an injury requiring surgical intervention.

Materials and methods

A retrospective cohort study was performed on 100 pediatric trauma patients with CT evidence of isolated free fluid between 2007 through 2020. Philips Tumor Tracker was used to determine fluid volume and density. Patients were divided into two groups: those without intraoperative evidence of injury (n = 93) and those with intraoperative evidence of injury (n = 7). Fluid volume, density, and pockets of fluid were compared between groups.

Results

Fluid volume, density, and number of fluid pockets were all statistically significantly different (p < 0.05). Average fluid volume was 4 ± 6 mL in non-injured patients and 31 ± 29 mL in injured patients. The highest density fluid collection was 13 ± 10 HU in non-injured patients and 40 ± 12 HU in injured patients. Specifically, a cutoff value of 5 mL had 100 % negative predictive value. 96 % of non-injured patients had free fluid in only one location, while 85 % of injured patients had fluid in multiple locations. All of the injured patients had fluid pockets other than or in addition to the pelvis. Additionally, fluid in the central mesentery was found only in injured patients.

Conclusion

Small volume, simple fluid in the pelvis of pediatric male or premenstrual female patients should not raise concern for underlying injury, even in a trauma setting.

Type of study

Retrospective cohort study.

Level of evidence

Level III.

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来源期刊

Journal of pediatric surgery 医学-外科

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.