英国成人和联合主要创伤中心小儿脾外伤处理的差异

IF 2.1 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Clinical radiology Pub Date : 2025-03-27 DOI:10.1016/j.crad.2025.106904

H. Sanchez-Lewis , P. Jenkins , L. Sorrell , L. Watkins , J. Zhong , J.E. Smith , V. Allgar , C. Roobottom , I. Mccafferty

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引用次数: 0

摘要

目的小儿脾损伤的治疗选择包括保守治疗、脾栓塞和脾切除术。在联合王国，除了独立的儿科创伤中心外，成人和联合（成人和儿科）主要创伤中心（mtc）接受创伤受伤的儿童。我们描述了2017年至2021年间英国成人和联合MTCs的儿科脾损伤治疗。材料和方法从创伤审计和研究网络（TARN）中提取2017年1月1日至21年12月31日在成人和联合MTCs中住院的所有18岁脾损伤患者的数据。使用卡方检验和Fisher精确检验评估损伤与中心类型、治疗和结局之间的关系。结果共纳入690例患儿。中位年龄为13.9岁（四分位数间距10.9 ~ 16.1），78.7%（543/690）为男性。92.9%（641/690）的患者为钝性损伤；7.1%（49/690）被穿透。在已知患者中，69.5%（182/262）采用联合MTC治疗，30.5%（80/262）采用成人MTC治疗。治疗包括：90.4%（624/690）接受保守治疗，5.5%（38/690）接受脾栓塞，4.1%（28/690）接受脾切除术。成人MTCs的栓塞率和脾切除术率分别为8.8%（7/80）和10%(8/80)，而合并MTCs的栓塞率和脾切除术率分别为4.4%（8/182）和1.6% (3/182)（P = 0.002）。没有栓塞患者需要后续脾切除术。成人死亡率为8.8%(7/80)，联合中心死亡率为3.3% (6/182)（P = 0.118）。结论栓塞术（5.5%）多于脾切除术（4.1%）。联合MTCs比单独的成人MTCs表现出更好的结果和更低的干预率。这些发现应该为英国儿科创伤护理的标准化策略提供信息。

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Variation in paediatric splenic trauma management in adult and combined major trauma centres in England

Aim

Treatment options for paediatric splenic injuries include conservative management, splenic embolisation, and splenectomy. Within the UK, in addition to standalone paediatric trauma centres, adult and combined (adult and paediatric) major trauma centres (MTCs) receive traumatically injured children. We describe the treatment of paediatric splenic injuries between 2017 and 2021 in the United Kingdom adult and combined MTCs.

Materials and Methods

Data were extracted from the Trauma Audit and Research Network (TARN) for all patients <18 years old with splenic injuries admitted between 01/01/17 and 31/12/21 at adult and combined MTCs. The relationship between injury and centre type, treatment, and outcomes was assessed using chi-squared and Fisher's exact tests.

Results

A total of 690 children were included. The median age was 13.9 years (interquartile range: 10.9-16.1), and 78.7% (543/690) of the patients were male. A total of 92.9% (641/690) of patients suffered blunt injuries; 7.1% (49/690) suffered penetrating. Of those known, 69.5% (182/262) were treated in a combined MTC and 30.5% (80/262) at an adult MTC.

Treatment included: A total of 90.4% (624/690) received conservative management, 5.5% (38/690) underwent splenic embolisation, and 4.1% (28/690) had a splenectomy. Embolisation and splenectomy rates at adult-only MTCs were 8.8% (7/80) and 10% (8/80), respectively, compared to 4.4% (8/182) and 1.6% (3/182) in combined MTCs (P = 0.002). No embolised patients required a subsequent splenectomy. The mortality rates were 8.8% (7/80) in adult and 3.3% (6/182) in combined centres (P = 0.118).

Conclusion

Embolisation is performed more (5.5%) than splenectomy (4.1%). Combined MTCs demonstrate superior outcomes and lower intervention rates than adult-only MTCs. These findings should inform strategies to standardise paediatric trauma care within the UK.

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来源期刊

Clinical radiology 医学-核医学

CiteScore

4.70

自引率

3.80%

发文量

528

审稿时长

76 days

期刊介绍： Clinical Radiology is published by Elsevier on behalf of The Royal College of Radiologists. Clinical Radiology is an International Journal bringing you original research, editorials and review articles on all aspects of diagnostic imaging, including: • Computed tomography • Magnetic resonance imaging • Ultrasonography • Digital radiology • Interventional radiology • Radiography • Nuclear medicine Papers on radiological protection, quality assurance, audit in radiology and matters relating to radiological training and education are also included. In addition, each issue contains correspondence, book reviews and notices of forthcoming events.