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Risk Factors and Timing of Fasciotomy for Isolated Pediatric Lower Extremity Trauma
Mennatalla Hegazi1, Jeffry Nahmias1,2, Michael Lekawa1,2
1Department of Surgery, Irvine School of Medicine, University of California, Orange, CA, USA.
Insights
Most fasciotomies for pediatric lower extremity trauma are delayed, often over 6 hours. Popliteal vein injury significantly increases the risk for this procedure in pediatric trauma patients.
Area of Science:
- Trauma Surgery
- Pediatric Orthopedics
- Vascular Surgery
Background:
- Single-center studies suggest delayed fasciotomy in pediatric trauma patients (PTPs) with compartment syndrome.
- This study investigates delayed fasciotomies in isolated pediatric lower extremity trauma (LET).
Purpose of the Study:
- To test the hypothesis that most fasciotomies in isolated pediatric lower extremity trauma are delayed (>6 hours from admission).
- To identify risk factors associated with pediatric fasciotomy.
Main Methods:
- Querying the 2017-2020 TQIP database for PTPs (<17 years) with isolated leg injuries.
- Performing multivariable logistic regression to identify risk factors for fasciotomy.
Main Results:
- 60.3% of fasciotomies were delayed, with a median time of 9.6 hours.
- Independent risk factors for fasciotomy included popliteal vein (OR 30.72), femoral vein (OR 18.19), popliteal artery (OR 13.74) injuries, and tibial fracture (OR 7.46).
- Fasciotomy patients had higher rates of severe LET, in-hospital complications, limb loss, and longer length of stay.
Conclusions:
- The majority of fasciotomies for pediatric lower extremity trauma are delayed.
- Popliteal vein injury is a significant risk factor for fasciotomy in this population.
- Delayed fasciotomy is associated with increased complications and longer hospital stays for pediatric trauma patients.
Abstract:
BackgroundPrevious single-center reports have demonstrated a longer time from traumatic leg injury to fasciotomy in pediatric trauma patients (PTPs) with compartment syndrome. We hypothesized most fasciotomies in isolated pediatric lower extremity trauma (LET) are delayed (>6 hours from admission) and sought to investigate risk factors for pediatric fasciotomy.MethodsThe 2017-2020 TQIP database was queried for PTPs <17 years old with isolated injury to the leg. The primary outcome was fasciotomy. A multivariable logistic regression analysis was performed to identify associated risk factors for fasciotomy.ResultsFrom 97,217 PTPs, 358 (0.4%) underwent a fasciotomy, with a majority being delayed (60.3%); the median time to fasciotomy was 9.6 hours. Patients undergoing fasciotomy were older (median age 14 vs 12 years, P < 0.001), had a higher rate of severe LET (4.9% vs 1.2%, P < 0.001), and had tibial fracture (70.7% vs 27.6%, P < 0.001). They also had increased rates of in-hospital complications (14.2% vs 0.6%, P < 0.001), limb loss (1.1% vs <0.1%, P < 0.001), and longer median length of stay (LOS) (5 vs 2 days, P < 0.001). The most injured vessel in those undergoing fasciotomy was the popliteal artery (9.9%). Independent risk factors associated with fasciotomy included injuries to the popliteal vein (OR 30.72, CI 11.06-85.29, P < 0.001), femoral vein (OR 18.19, CI 6.40-51.69, P < 0.001), and popliteal artery (OR 13.74, CI 8.45-22.34, P < 0.001) and tibial fracture (OR 7.46, CI 5.57-10.00, P < 0.001).DiscussionMost fasciotomies were delayed for PTPs with isolated lower extremity injury. Popliteal vein injury increases the risk for fasciotomy 30-fold. Patients undergoing fasciotomy tend to have more complications and longer LOS.
