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Application of lower extremity injury severity scores in children
David A Stewart1, Christopher J Coombs, H Kerr Graham
1Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Melbourne, Australia ; University of Melbourne, Parkville, Melbourne, Australia ; 3W Clinical Offices, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052 Australia.
Insights
Injury severity scores for severe lower extremity trauma are not reliable for children. These scores showed poor specificity, incorrectly suggesting amputation for limbs that were successfully reconstructed.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Limb Reconstruction
Background:
- Severe lower extremity trauma in children poses complex treatment decisions.
- Existing injury severity scores are primarily validated in adult populations.
- Limited data exists on the applicability of these scores in pediatric trauma.
Purpose of the Study:
- To evaluate the utility of established injury severity scoring systems in pediatric lower extremity trauma.
- To determine if current scores accurately predict the need for amputation in children.
- To assess the performance of various scores in a pediatric cohort.
Main Methods:
- Retrospective review of pediatric patients with severe lower limb trauma (2000-2010).
- Inclusion of data on injury details, surgical interventions, and amputation outcomes.
- Application and analysis of multiple established scoring systems: Mangled Extremity Severity Score, Limb Salvage Index, Predictive Salvage Index, Nerve injury, Ischaemia, Soft tissue injury, Skeletal injury, Shock, Age System, and Hanover Fracture Scale 1998.
Main Results:
- Twenty children (average age 8.7 years) were analyzed.
- Three primary amputations occurred; no secondary amputations were performed.
- All evaluated scoring systems demonstrated poor specificity, recommending amputation for limbs that were ultimately salvaged.
Conclusions:
- Current injury severity scores function differently in pediatric versus adult trauma patients.
- The existing scoring systems, in their current format, are not suitable for guiding early amputation decisions in children.
- Further research is needed to develop pediatric-specific criteria for limb salvage versus amputation.
Purpose:
Severe lower extremity trauma presents challenges in decision-making in terms of reconstruction or amputation. While injury severity scores have been developed to aid decision-making in adults, evaluation of their use in children is limited.
Methods:
Children presenting with severe lower limb trauma from 2000 to 2010 in a major trauma centre were identified from a trauma registry. Records were reviewed for details of the injury, surgical intervention, amputation and scores for the Mangled Extremity Severity Score, Limb Salvage Index, Predictive Salvage Index, Nerve injury, Ischaemia, Soft tissue injury, Skeletal injury, Shock, Age System and the Hanover Fracture Scale 1998.
Results:
Twenty children (average age 8.7 years) were eligible for inclusion. There were three primary amputations and no secondary amputations. All of the scoring systems had poor specificity and would have recommended amputation in several limbs that were successfully reconstructed.
Conclusions:
Currently available injury severity scores behave differently in children and adults. In their current format, these scores should not be used as an absolute indication for early amputation in children.
