Yuan Yuanhong,Zhang Hui,Xiao Zhenghui,et al.Clinical study on interhospital transport of pediatric patients with critical surgical injuries[J].Journal of Clinical Pediatric Surgery,,22():649-654.[doi:10.3760/cma.j.cn101785-202303068-009]
Clinical study on interhospital transport of pediatric patients with critical surgical injuries
- Keywords:
- Wounds and Injuries; Critical Illness; Referral and Consultation; Surgical Procedures; Operative; Child
- Abstract:
- Objective To review the clinical data of critical pediatric surgical trauma patients transported from hospital to hospital and provide suggestions for safe and effective transport.Methods Clinical data were retrospectively reviewed for 232 critically injured children actively transported between hospitals from January 2015 to January 2022 analyzed.According to whether or not pediatric trauma score (PTS) was ≥ 8, they were assigned into two groups of non-serious injury (PTS ≥ 8, n=108) and serious injury (PTS<8, n=124).General profiles, causes and sites of trauma, treatment during transport and adverse events of two groups were compared and treatment and outcomes of children with different causes of trauma examined. Results There were 160 boys (69.0%) and 72 girls (31.0%) with an average age of 54 months.The age group of (3-6) years was the largest number of children (n=96, 41.3%).The median transport distance was 72 km and the total transport time (2.68±1.06) hour.Gender (boy/girl:76/32 vs.84/40), age[<1 year/1-3 years (including 3 years)/3-6 years/>6 years:11/20/42/35 vs.13/26/54/31], transport distance (0~100 km/100~200 km/>200 km):62/30/16 vs.66/41/27) had no statistical significance (P>0.05).However, statistical significance (P<0.05) existed in transit time (<1 h/1-2 h/>2 h:40/45/23 vs.22/64/38).In terms of causes, collision injury was the most common;as for site, craniocerebral injury was the most common.In terms of causes (collision/height fall/traffic accident/others:77/12/10/9 vs.12/52/43/17) and site (craniocerebral injury/limb fracture/multiple injuries/other:34/38/11/25 vs.38/26/39/21), the differences were statistically significant (P<0.001).No serious adverse events such as respiratory & cardiac arrest occurred during transport.Both groups were treated en route (mechanical ventilation/sedative analgesics/vasoactive agents/fluid resuscitation:(3/6/2/2 vs.14/16/6/6) and adverse events (airway catheter withdrawal/retention needle withdrawal/cyanosis/cardiac & respiratory arrest:no significant difference between 1/1/1/0 and 3/2/2/0) (P>0.05).After hospitalization:223 children (96.1%) were operated and 9 (3.9%) received non-surgical treatment.The inter-group difference in composition ratio of surgical treatment was statistically significant (P<0.001).Outcome:221 cases improved/cured (95.3%), 6 disabled/sequelae (2.6%) and 5 (2.2%) died.The inter-group difference in outcome composition ratio was statistically significant (P<0.001).Conclusion Equipped with professional transport team and transport equipment, accurate assessment and communication of condition before transport, close monitoring of the changes of condition during transport and timely treatment after transport, children may undergo timely and effective surgery and receive optimal interventions.Thus it is feasible to improve the safety and prognosis of inter-hospital transport of critically injured children.
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Memo
收稿日期:2023-03-31。
基金项目:湖南省科技厅临床医疗技术创新引导项目（2021SK50501）；湖南省科技创新重点工程项目（2020SK10141-3）；湖南省科技厅重点实验室项目（2018TP1028）
通讯作者:肖政辉,Email:xzh2010@163.com