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Published on: May 31, 2019
Risk factors for developing acute compartment syndrome in the pediatric population: a systematic review and
Sharri J Mortensen1, Sebastian Orman2, Edward J Testa2
1Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA. Sharri.j.mortensen@gmail.com.
Insights
Pediatric acute compartment syndrome (ACS) risk factors include open fractures and high-energy trauma. Male gender and concurrent fractures also increase ACS risk in children, aiding prompt diagnosis.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Emergency Medicine
Background:
- Acute compartment syndrome (ACS) presents diagnostic challenges in pediatric patients due to varied symptoms.
- Early identification of at-risk children is crucial for timely diagnosis and intervention.
- Understanding risk factors can improve clinical suspicion and management of pediatric ACS.
Purpose of the Study:
- To identify specific risk factors associated with the development of traumatic acute compartment syndrome in pediatric patients.
- To provide evidence-based insights for clinicians managing pediatric trauma to recognize potential ACS cases.
Main Methods:
- Systematic review and meta-analysis of existing studies involving pediatric patients with traumatic ACS.
- Inclusion criteria focused on traumatic ACS, excluding other causes like exertion or burns.
- Random-effects meta-analysis was employed to pool data and address heterogeneity.
Main Results:
- Analysis of nine studies involving 380,411 patients, with 1144 diagnosed with traumatic ACS.
- Significant risk factors identified: open radius/ulna fractures (OR 3.56), high-energy trauma (OR 3.51), concurrent humerus and forearm fractures (OR 3.49), open tibia fractures (OR 2.29), and male gender (OR 2.06).
- Average patient age was 10 years, with 67% males.
Conclusions:
- Open fractures, high-energy trauma, combined humerus and forearm fractures, and male gender are significant predictors of ACS in pediatric patients.
- Clinicians should maintain a high index of suspicion for ACS when these factors are present in pediatric trauma cases.
- This study highlights key indicators to facilitate earlier diagnosis and management of pediatric traumatic ACS.
Purpose:
Acute compartment syndrome (ACS) is often difficult to diagnose in pediatric patients due to their erratic symptomatology. Therefore, it is of paramount importance to identify at-risk patients to facilitate a prompt diagnosis. This study aims to identify risk factors for the development of ACS in the pediatric population.
Methods:
We included studies comprised of pediatric patients with traumatic ACS. We excluded studies evaluating compartment syndrome secondary to exertion, vascular insult, abdominal processes, burns, and snake bites. Heterogeneity was addressed by subgroup analysis, and whenever it remained significant, we utilized a random-effects meta-analysis for data pooling. The protocol has been registered at PROSPERO (ID = CRD42019126603).
Results:
We included nine studies with 380,411 patients, of which 1144 patients were diagnosed with traumatic ACS. The average age was 10 years old, and 67% of patients were male. Factors that were significantly associated with ACS were: open radius/ulna fractures (OR 3.56 CI 1.52-8.33, p = 0.003), high-energy trauma (OR 3.51 CI 1.71-7.21, p = 0.001), humerus fractures occurring concurrently with forearm fractures (OR 3.49 CI 1.87-6.52, p < 0.001), open tibia fractures (OR 2.29 CI 1.47-3.55, p < 0.001), and male gender (OR 2.06 CI 1.70-2.51, p < 0.001).
Conclusion:
In the present study, open fractures, high-energy trauma, concurrent humerus and forearm fractures, and male gender significantly increased the risk of developing ACS in the pediatric population. Clinicians should raise their suspicion for ACS when one or multiple of these factors are present in the right clinical context.
Type Of Study:
Systematic review and meta-analysis.
Level Of Evidence:
III.
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