Early vasopressor administration in pediatric blunt liver and spleen injury: An ATOMAC+ study.
Blunt trauma
Nonoperative management
Pediadiatric trauma
Vasopressor
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
15
04
2020
revised:
23
06
2020
accepted:
02
07
2020
pubmed:
12
8
2020
medline:
25
6
2021
entrez:
12
8
2020
Statut:
ppublish
Résumé
No prior studies have examined the outcomes of early vasopressor use in children sustaining blunt liver or spleen injury (BLSI). A planned secondary analysis of vasopressor use from a 10-center, prospective study of 1004 children with BLSI. Inverse probability of treatment weighting (IPTW) was used to compare patients given vasopressors <48 h after injury to controls based on pretreatment factors. A logistic regression was utilized to assess survival associated with vasopressor initiation factors on mortality and nonoperative management (NOM) failure. Of 1004 patients with BLSI, 128 patients were hypotensive in the Pediatric Trauma Center Emergency Department (ED); 65 total patients received vasopressors. Hypotension treated with vasopressors was associated with a sevenfold increase in mortality (AOR = 7.6 [p < 0.01]). When excluding patients first given vasopressors for cardiac arrest, the risk of mortality increased to 11-fold (AOR = 11.4 [p = 0.01]). All deaths in patients receiving vasopressors occurred when started within the first 12 h after injury. Vasopressor administration at any time was not associated with NOM failure. After propensity matching, early vasopressor use for hypotension in the ED was associated with an increased risk of death, but did not increase the risk of failure of NOM. Level III prognostic and epidemiological, prospective.
Sections du résumé
BACKGROUND
BACKGROUND
No prior studies have examined the outcomes of early vasopressor use in children sustaining blunt liver or spleen injury (BLSI).
METHODS
METHODS
A planned secondary analysis of vasopressor use from a 10-center, prospective study of 1004 children with BLSI. Inverse probability of treatment weighting (IPTW) was used to compare patients given vasopressors <48 h after injury to controls based on pretreatment factors. A logistic regression was utilized to assess survival associated with vasopressor initiation factors on mortality and nonoperative management (NOM) failure.
RESULTS
RESULTS
Of 1004 patients with BLSI, 128 patients were hypotensive in the Pediatric Trauma Center Emergency Department (ED); 65 total patients received vasopressors. Hypotension treated with vasopressors was associated with a sevenfold increase in mortality (AOR = 7.6 [p < 0.01]). When excluding patients first given vasopressors for cardiac arrest, the risk of mortality increased to 11-fold (AOR = 11.4 [p = 0.01]). All deaths in patients receiving vasopressors occurred when started within the first 12 h after injury. Vasopressor administration at any time was not associated with NOM failure.
CONCLUSION
CONCLUSIONS
After propensity matching, early vasopressor use for hypotension in the ED was associated with an increased risk of death, but did not increase the risk of failure of NOM.
LEVEL OF EVIDENCE
METHODS
Level III prognostic and epidemiological, prospective.
Identifiants
pubmed: 32778447
pii: S0022-3468(20)30485-1
doi: 10.1016/j.jpedsurg.2020.07.007
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
500-505Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.