Case series: Factors of mortality in pediatric patients with pelvic fractures

• Published in: Injury Vol. 53; no. 6; pp. 2081 - 2086
• Main Authors: Horowitz, Roy S., Goldman, Vladimir, Simanovsky, Naum, Zaidman, Michael
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.06.2022
• Subjects: DCO; ETC; Fracture; Pediatrics; Pelvic ring; Pediatrics; DCO; Fracture; ETC; Pelvic ring
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2022.04.011

•Thoracic trauma, consumptive coagulopathy and a high ISS score are poor prognostic factors in pediatric patients with pelvic fractures.•No difference in mortality was found between conservative treatment, Early Total Care or Damage Control Orthopedics for pediatric patients with pelvic fractures.•The deceased displayed a flare of the innate immune system, which did not subside over time. 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. A retrospective trauma database for pediatric pelvic fractures from 2002-2018 was gathered, and patient charts were reviewed. 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. 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.