Pediatric amputation injuries: etiology, cost, and outcome

To provide a comprehensive profile of amputation injuries in children and adolescents.

A retrospective case series.

All patients 18 years old or less, admitted to the regional Level I trauma center hospital with a traumatic amputation injury over a 10-year period (74 patients, 77 extremities) were included in the study. Etiology and mechanism of injury, length of hospital stay, number of surgeries and procedures, presence of infection, final outcome of injury (amputation vs. salvage), anatomic location of final outcome, and total charges were recorded for each patient.

There were 47 injuries to the upper extremity, and 30 to the lower extremity. The average length of stay was 11.3 days, with a mean of 4.3 procedures in 2.3 surgeries and average charges of $22,015. Twenty-two percent of the injuries were caused by power lawn mowers; all of these patients had amputations. Motor vehicle related crashes accounted for 16% of all injuries; 77% of these ultimately had amputations. Gunshot wounds had the highest mean length of hospital stay, surgery days, number of procedures, and charges. Out of 32 extremities that were revascularized for attempted salvage, 27 were successful (84%), all in the upper extremity, and all but one were digits.

Injuries caused by a sharp mechanism with a smaller area of involvement are more likely to be successfully salvaged with revascularization, regardless of ischemic time. Long-term follow-up is needed to evaluate final functional and psychosocial outcome. Lawn mowers represent a serious hazard to children, and should be addressed through changes in engineering and parent education.