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Case series: Factors of mortality in pediatric patients with pelvic fractures
Roy S Horowitz1, Vladimir Goldman1, Naum Simanovsky1
1Hadassah Hospital Ein Kerem, Hadassah Medical Center, Jerusalem, Israel.
Insights
Prognostic factors for pediatric pelvic fractures are similar to adults. Most pediatric patients survive pelvic trauma, regardless of treatment approach: conservative, early total care, or damage control orthopedics.
Area of Science:
- Orthopedic Surgery
- Pediatric Trauma
- Pelvic Fractures
Background:
- Limited research exists on pediatric pelvic fracture treatment algorithms.
- Adult studies dominate the analysis of pelvic fracture prognoses.
- A need exists for pediatric-specific prognostic factors and treatment guidance.
Purpose of the Study:
- Identify prognostic factors for pediatric pelvic fractures.
- Evaluate the safety and efficacy of early total care in pediatric pelvic fractures.
- Provide data to guide orthopedic treatment decisions in children.
Main Methods:
- Retrospective review of a trauma database for pediatric pelvic fractures (2002-2018).
- Analysis of patient charts to extract relevant clinical data.
- Identification of prognostic indicators associated with outcomes.
Main Results:
- Motor vehicle accidents (77%) and falls (15%) were primary causes.
- Higher incidence in males (71%) and older children (33% aged 15-16).
- Mortality linked to thoracic trauma, altered neutrophil counts, coagulation abnormalities (Prothrombin Time, International Normalized Ratio, Partial Thromboplastin Time), higher Injury Severity Score, and lower systolic blood pressure.
Conclusions:
- Prognostic factors in pediatric pelvic fractures mirror those in adults.
- Pediatric patients demonstrate resilience, surviving pelvic trauma across various treatment strategies.
- Treatment approaches including conservative management, early total care, and damage control orthopedics are survivable.
Objective:
No algorithm exists to guide the orthopedic treatment of pediatric patients with pelvic fractures, as most analytic studies have been conducted in adults. The goal of this study was to identify prognostic factors of pelvic fractures, and suggest whether early total care can be safely provided.
Methods:
A retrospective trauma database for pediatric pelvic fractures from 2002-2018 was gathered, and patient charts were reviewed.
Results:
A total of 128 patients were evaluated for pelvic trauma; 99 injuries were secondary to motor vehicle accidents (MVA) (77%), and 19 were secondary to falls (15%). Patients were more likely to be male (71%), older (33% aged 15-16 years, 2% aged 0-1 years), to experience a head trauma (55%), to be treated conservatively (70%), and to survive their trauma (91%). About half of the patients (49%) experienced an additional extremity trauma. When exploring the prognostic factors, mortality was associated with thoracic trauma (72% vs. 27%, p<0.05); a lower reduction of neutrophils levels 48 hours after the initial trauma (-1.34 vs. -7.7, p<0.05); a more significant reduction upon arrival of Prothrombin Time (72% vs. 37%, p<0.01), and an increment of International Normalized Ratio (2.29 vs. 1.26, p<0.01) and Partial Thromboplastin Time (79 vs 28, p<0.01). There was also a higher demand for Fresh Frozen Plasma (24% vs. 9%, p<0.05); Upon presentation, there was a higher Injury Severity Score (49 vs. 21, p<0.001), and a lower systolic Blood Pressure (96 vs. 118, p<0.05); The deceased did not have a very prolonged stay in the hospital (3 days vs. 12 days, P<0.01); Mortality was not significantly associated with either Early Total Care or Damage Control Orthopedics.
Conclusions:
Prognostic factors in pediatric patients with pelvic fractures parallel those of the adult population. Pediatric patients tendentiously outlive their pelvic trauma, whether the course of action taken by their surgeons is Conservative by nature, Early Total Care or Damage Control Orthopedics.
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