부산대학교 도서관

BACKGROUND: The role of emergency department resuscitative thoracotomy (EDT) in traumatically injured children has not been elucidated. We aimed to perform a systematic review and create evidence-based guidelines to answer the following PICO question: should pediatric patients who present to the emergency department (ED) pulseless (with or without signs of life (SOL)) after traumatic injuries (penetrating thoracic, penetrating abdominopelvic, or blunt) undergo EDT (versus no EDT) to improve survival and neurologically intact survival? METHODS: Using GRADE methodology, a group of 12 pediatric trauma experts from the PTS, WTA, and EAST assembled to perform a systematic review. A consensus conference was conducted, a database was queried, abstracts and manuscripts were reviewed, data extraction was performed, and evidence quality was determined. Evidence tables were generated, and the committee voted on guideline recommendations. RESULTS: Three hundred and three articles were identified. Eleven studies met inclusion criteria and were used for guideline creation, providing 319 pediatric patients who underwent EDT. No data were available on patients who did not undergo EDT. For each PICO, the quality of evidence was very low based on the serious risk of bias and serious or very serious imprecision. CONCLUSIONS: Based on low-quality data we make the following recommendations. We conditionally recommend EDT when a child presents pulseless with SOL to the ED following penetrating thoracic injury and penetrating abdominopelvic injury, and after blunt injury if emergency adjuncts point to a thoracic source. We conditionally recommend against EDT when a pediatric patient presents pulseless without SOL after penetrating thoracic and penetrating abdominopelvic injury. We strongly recommend against EDT in the patient without SOL after blunt injury. LEVEL OF EVIDENCE: Guideline/Systematic Review, level III