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Risk Factors for Compartment Syndrome in Pediatric Trauma Patients
Jennifer A Sees1,2, Gretchen J Cutler2, Henry W Ortega2
1From the University of Minnesota.
Insights
Older male pediatric trauma patients with lower limb fractures or firearm injuries face higher risks of compartment syndrome (CS). Identifying these risk factors aids in prompt diagnosis and treatment.
Area of Science:
- Pediatric Trauma Surgery
- Orthopedic Surgery
- Emergency Medicine
Background:
- Compartment syndrome (CS) is a surgical emergency that can lead to permanent disability.
- Identifying pediatric trauma patients at higher risk for CS is crucial for early detection and intervention.
Purpose of the Study:
- To determine the risk factors associated with the development of compartment syndrome in pediatric trauma patients.
- To inform clinical practice and improve outcomes for pediatric trauma patients at risk of CS.
Main Methods:
- Analysis of a large cohort of pediatric trauma patients (under 19 years) from the National Trauma Data Bank (2009-2012).
- Multivariable logistic regression was employed to identify significant risk factors for CS.
- Statistical models were adjusted for demographic, clinical, and injury-specific variables.
Main Results:
- Older pediatric patients (aged 2-18 years) demonstrated significantly increased odds of developing CS compared to younger children (1 year or younger).
- Male sex, lower limb fractures, and firearm-related injuries were independently associated with a higher likelihood of CS.
- The incidence of CS in the study population was 0.3%.
Conclusions:
- Key risk factors for compartment syndrome in pediatric trauma include older age, male sex, lower limb fractures, and firearm injuries.
- This information can guide clinicians in identifying high-risk individuals, enabling timely diagnosis and treatment of CS.
- Early recognition and management of CS are critical to prevent severe complications in pediatric trauma patients.
Objective:
This study aimed to identify risk factors for compartment syndrome (CS) in pediatric trauma populations.
Methods:
We included patients younger than 19 years treated at trauma centers contributing to the National Trauma Data Bank between 2009 and 2012. Multivariable logistic regression was used to examine the association between risk factors and the development of CS. The final model adjusted for age, sex, race, number of comorbidities, Glascow Coma Scale, Injury Severity Score, mechanism of injury, and fracture of the lower limb.
Results:
A total of 341,238 patients were eligible for analysis, and 896 patients developed CS (0.3%). In adjusted regression models, older patients had significantly higher odds of CS compared with patients 1 years or younger (odds ratio [OR], 3.29 [95% confidence interval [CI], 1.29-8.37; 2-6 years]; OR, 7.55 [95% CI, 3.08-18.55 [7-12 years]; OR, 10.34 [95% CI, 4.26-25.09 [13-18 years]). Male patients had significantly increased odds of CS compared with female patients, as did patients with lower limb fractures compared with patients without lower limb fractures (OR, 1.93 [95% CI, 1.56-2.40]; OR, 7.61 [95% CI, 6.48-8.94]; respectively). Finally, patients with a firearm injury had higher odds of CS compared with other mechanisms of injury (OR, 3.51 [95% CI, 2.70-4.56]).
Conclusions:
Older pediatric trauma patients, male patients, and those with lower limb fractures and firearm injuries have increased odds of CS. Information on risk factors can be used to help identify patients most likely to develop CS, facilitating timely diagnosis and treatment.
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