La tríada crítica en el trauma pediátrico: Construcción de un modelo predictivo para transfusión masiva
DOI:
https://doi.org/10.30944/20117582.3058Palabras clave:
transfusión de componentes sanguíneos, heridas y lesiones, pediatría, centros traumatológicos, medición de riesgo, algoritmos de predicciónResumen
Introducción. Las lesiones por trauma son un problema de salud pública. En la población pediátrica producen más años de vida perdidos que las enfermedades infecciosas y el cáncer. Una de las primeras causas de mortalidad en los niños es la exanguinación. Los protocolos de transfusión masiva y los predictores para activarlos han demostrado disminución de la mortalidad en los adultos. El objetivo de este estudio fue identificar los predictores de transfusión masiva (TM) en pacientes pediátricos con lesiones traumáticas y desarrollar un sistema de predicción en un centro de trauma en Cali, Colombia.
Métodos. Estudio de cohorte retrospectiva en pacientes menores de 18 años con trauma que recibieron hemocomponentes en un centro de trauma entre 2011 y 2019. Se definió TM como la administración ≥ 40 ml/ kg/24 horas. Se recolectaron variables clínicas, fisiológicas y transfusionales. Se creó un modelo que fue validado internamente.
Resultados. Ingresaron 1430 pacientes por trauma; 200 recibieron transfusión. La regresión logística multivariable mostró como predictores de TM las lesiones severas en tórax (OR 3,11; RIC 1,22–7,93) y abdomen (OR 5,12; RIC 2,04–12,84) y la variable creada a partir del inverso del índice de shock multiplicada por el GCS [rSIG] (OR 0,89; RIC 0,83–0,95). El modelo mostró una buena capacidad discriminativa (AUROC 0,74; IC95% 0,67–0,82) y ajuste (Hosmer-Lemeshow p=0,59).
Conclusión. La inclusión de variables clínicas (como rSIG) y de severidad anatómica en un modelo predictivo de TM en trauma pediátrico permite desarrollar herramientas que mejoran la toma de decisiones en contextos críticos.
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