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Trauma em idade pediátrica : revisão casuística numa unidade de cuidados intensivos pediátricos de um centro de trauma nível I
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Abstract(s)
Introdução e Objetivo: O trauma físico permanece uma causa importante de morbimortalidade em Pediatria, apesar da melhoria na prevenção primária e cuidados de saúde. Pretende-se fazer uma revisão da patologia traumática que motivou internamento numa unidade de cuidados intensivos pediátricos de um Centro de Trauma Nível I. Métodos: Estudo retrospetivo dos internamentos por trauma físico na UCIPed do HSM-CHULN, de 01/01/2015 a 31/12/2019. Analisados dados demográficos, clínicos, tipo de evento, mecanismo da lesão e evolução clínica. Resultados: Foram internadas 161 crianças (8,3% das admissões), 67,1% do sexo masculino, idade média de 10,1 anos. A taxa de mortalidade foi de 3,7% (6 óbitos), idade média de 8,5 anos (σ=4,7 anos). O principal local do trauma foi a rua (70,8%), em 54% dos doentes foi efetuado transporte primário para o HSM-CHULN. O acidente de viação foi o mecanismo mais frequente (51,6%). Existiu um predomínio de trauma contuso (94,4%) e de politrauma (67%). O traumatismo cranioencefálico (TCE) foi o mais frequente, tanto em monotrauma (74,6%) como em politrauma (71,8%), diretamente relacionado com o óbito em 5 doentes. Houve necessidade de suporte respiratório em 54,7% dos doentes, 33,5% tiveram suporte neurológico, 32,3% necessitaram de hemoderivados e 16,8% de suporte vasoativo. Efetuada intervenção cirúrgica em 57,1%. Na escala PTS verificou-se uma mediana global de 8 (-3; 12) e de 2,5 (-3; 8) no grupo dos óbitos. Duração média de internamento na UCIPed de 3,0 dias (σ=3,6 dias), total hospitalar de 18 dias (σ=18,3 dias), 79,5% de altas para o domicílio. Na avaliação na alta a maioria dos doentes teve PCPC – 1 (função cerebral normal - 55,3%) e POPC - 3 (limitação geral moderada - 44,1%). Conclusão: Verificou-se um predomínio do politrauma associado a acidentes de viação e uma maior morbimortalidade associada ao TCE. Para melhor caracterização da realidade nacional são necessários estudos prospetivos e multicêntricos.
Introduction and Objective: Physical trauma remains a significant cause of morbidity and mortality in pediatric patients, despite improvements in primary prevention and healthcare. This study aims to review the characteristics of trauma patients admitted to a pediatric intensive care unit at a Level 1 Trauma Centre. Methods: Retrospective study of trauma patients admitted to a PICU (UCIPed, HSM-CHULN) between 01/01/2015 and 31/12/2019. Demographic, clinical, trauma type, injury mechanism and clinical evolution data was analysed. Results: A total of 161 trauma patients (8.3% of admissions), 67.1% male, mean age of 10.1 years. Mortality rate was 3.7% (6 deaths), mean age 8.5 years (σ=4.7 years). Main site of injury was the street (70.8%) and in 54% of cases, patients were primarily transported to HSM-CHULN. Road traffic injury was the most common trauma mechanism (51.6%). Blunt trauma was the most common trauma type (94.4%) and polytrauma predominated (67%). Traumatic brain injuries (TBI) were the most frequent, isolated (74.6%) and in polytrauma (71.8%), directly related to cause of death in 5 patients. In 54.7% of patients, mechanical invasive ventilation was required, 33.5% needed neurological support, 32.3% required blood products and 16.8% vasoactive support. Surgery was performed in 57.1% of patients. On the PTS the total population median was 8 (-3; 12) and 2.5 (-3; 8) in the non-survivor group. Mean time of stay in UCIPed was 3.0 days (σ=3.6 days) and total hospital stay was 18.0 days (σ=18.3 days). Most patients (79.5%) were discharged home. At discharge, most patients scored PCPC – 1 (normal cerebral function – 55.3%) and POPC – 3 (moderate overall disability – 44.1%). Conclusion: Polytrauma predominated associated with road traffic injuries. Traumatic brain injury was associated with greater morbidity and mortality. Prospective, multicentre studies are required for a better characterization of the national trauma reality.
Introduction and Objective: Physical trauma remains a significant cause of morbidity and mortality in pediatric patients, despite improvements in primary prevention and healthcare. This study aims to review the characteristics of trauma patients admitted to a pediatric intensive care unit at a Level 1 Trauma Centre. Methods: Retrospective study of trauma patients admitted to a PICU (UCIPed, HSM-CHULN) between 01/01/2015 and 31/12/2019. Demographic, clinical, trauma type, injury mechanism and clinical evolution data was analysed. Results: A total of 161 trauma patients (8.3% of admissions), 67.1% male, mean age of 10.1 years. Mortality rate was 3.7% (6 deaths), mean age 8.5 years (σ=4.7 years). Main site of injury was the street (70.8%) and in 54% of cases, patients were primarily transported to HSM-CHULN. Road traffic injury was the most common trauma mechanism (51.6%). Blunt trauma was the most common trauma type (94.4%) and polytrauma predominated (67%). Traumatic brain injuries (TBI) were the most frequent, isolated (74.6%) and in polytrauma (71.8%), directly related to cause of death in 5 patients. In 54.7% of patients, mechanical invasive ventilation was required, 33.5% needed neurological support, 32.3% required blood products and 16.8% vasoactive support. Surgery was performed in 57.1% of patients. On the PTS the total population median was 8 (-3; 12) and 2.5 (-3; 8) in the non-survivor group. Mean time of stay in UCIPed was 3.0 days (σ=3.6 days) and total hospital stay was 18.0 days (σ=18.3 days). Most patients (79.5%) were discharged home. At discharge, most patients scored PCPC – 1 (normal cerebral function – 55.3%) and POPC – 3 (moderate overall disability – 44.1%). Conclusion: Polytrauma predominated associated with road traffic injuries. Traumatic brain injury was associated with greater morbidity and mortality. Prospective, multicentre studies are required for a better characterization of the national trauma reality.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Keywords
Trauma físico pediátrico Cuidados intensivos pediátricos Mecanismo de lesão Tipo de trauma Prevenção Pediatria