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European Journal of Trauma and Emergency Surgery

Erschienen in:

13.02.2019 | Original Article

Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO—an analysis of 316 pediatric trauma patients from the TraumaRegister DGU^®

verfasst von: Klemens Horst, Hagen Andruszkow, Christian David Weber, Miguel Pishnamaz, Matthias Knobe, Felix Marius Bläsius, Philipp Lichte, Rolf Lefering, Frank Hildebrand

Erschienen in: European Journal of Trauma and Emergency Surgery | Ausgabe 5/2019

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Abstract

Purpose

External fixation within the damage control concept in unstable multiple trauma patients is widely accepted. Literature about its usage in the pediatric trauma population, however, is rare. The aim of the present study was to elucidate the factors associated with the application of external fixation in the severely injured child.

Methods

Patients with severe trauma aged 0–54 years documented in the TraumaRegister DGU^® were included in this study. Demographic data, pattern of injury, injury severity, use of the damage control orthopedics (DCO) or early total care (ETC) concept, duration of mechanical ventilation, intensive care stay, and total hospital stay as well as the occurrence of complications and mortality were evaluated. Statistical evaluation was performed using SPSS (Version 21.0.0) using Chi square tests and linear regression models.

Results

While injury severity was comparable between children and adults, type of accident and injury patterns showed significant differences, Overall, the majority of surgical fracture stabilization in AIS_Extremity ≥ 3 injuries followed the DCO concept in adults (60.3%) and the ETC protocol in children (49.4%). Conservative treatment was chosen for only 11.6% of all children and 9.6% of all adults. An increasing injury severity, AIS_Extremity ≥ 3 and AIS_Extremity ≥ 3 in ≥ 2 body regions, and a more advanced age were found to be independent factors in the use of the DCO concept in children.

Conclusion

Use of external fixation increases with age and plays a minor role in the very young trauma population. However, this does not produce a difference in outcome between children and adults.

Pediatric trauma. Advanced trauma life support for doctors (ATLS) Student course manual. 9th ed. Chicago: American College of Surgeons; 2012. pp. 246–70.

Peden M, Oyegbite K, Ozanne-Smith J, Hyder AA, Branche C, AKMF R. World report on child injury prevention. 2008. http://www.who.int/violence_injury_prevention/child/injury/world_report/en. Accessed 30 May 2017.

Banerjee M, Bouillon B, Shafizadeh S, Paffrath T, Lefering R, Wafaisade A. Epidemiology of extremity injuries in multiple trauma patients. Injury. 2013;44(8):1015–21. https://doi.org/10.1016/j.injury.2012.12.007.CrossRefPubMed

Pape HC, Tornetta P 3rd, Tarkin I, Tzioupis C, Sabeson V, Olson SA. Timing of fracture fixation in multitrauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg. 2009;17(9):541–9.CrossRef

Klassen TP, Hartling L, Craig JC, Offringa M. Children are not just small adults: the urgent need for high-quality trial evidence in children. PLoS Med. 2008;5(8):e172. https://doi.org/10.1371/journal.pmed.0050172.CrossRefPubMedPubMedCentral

Capizzani AR, Drongowski R, Ehrlich PF. Assessment of termination of trauma resuscitation guidelines: are children small adults? J Pediatr Surg. 2010;45(5):903–7. https://doi.org/10.1016/j.jpedsurg.2010.02.014.CrossRefPubMed

TraumaRegister DGU. 20 years TraumaRegister DGU((R)): development, aims and structure. Injury. 2014;45(Suppl 3):6–13. https://doi.org/10.1016/j.injury.2014.08.011.CrossRef

Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800.CrossRef

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.CrossRef

10.

Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55.CrossRef

11.

Lefering R, Huber-Wagner S, Nienaber U, Maegele M, Bouillon B. Update of the trauma risk adjustment model of the TraumaRegister DGU: the Revised Injury Severity Classification, version II. Crit Care. 2014;18(5):476. https://doi.org/10.1186/s13054-014-0476-2.CrossRefPubMedPubMedCentral

12.

Reichmann I, Aufmkolk M, Neudeck F, Bardenheuer M, Schmit-Neuerburg KP, Obertacke U. Comparison of severe multiple injuries in childhood and adulthood. Unfallchirurg. 1998;101(12):919–27.CrossRef

13.

Remmers D, Regel G, Neumann C, Pape HC, Post-Stanke A, Tscherne H. Pediatric polytrauma. A retrospective comparison between pediatric, adolescent and adult polytrauma. Unfallchirurg. 1998;101(5):388–94.CrossRef

14.

Burdi AR, Huelke DF, Snyder RG, Lowrey GH. Infants and children in the adult world of automobile safety design: pediatric and anatomical considerations for design of child restraints. J Biomech. 1969;2(3):267–80.CrossRef

15.

Richter T, Ragaller M. Ventilation in chest trauma. J Emerg Trauma Shock. 2011;4(2):251–9. https://doi.org/10.4103/0974-2700.82215.CrossRefPubMedPubMedCentral

16.

Hoekelman RA, Pless IB. Decline in mortality among young Americans during the 20th century: prospects for reaching national mortality reduction goals for 1990. Pediatrics. 1988;82(4):582–95.PubMed

17.

Gill AC, Kelly N. Overview of pediatric injury prevention: epidemiology; history, application. In: UpToDate. 2016. https://www.uptodate.com/contents/pediatric-injury-prevention-epidemiology-history-and-application. Accessed 04 Aug 2017.

18.

O’Brien PJ. Fracture fixation in patients having multiple injuries. Can J Surg. 2003;46(2):124–8.PubMedPubMedCentral

19.

Pape HC, Giannoudis P, Krettek C. The timing of fracture treatment in polytrauma patients: relevance of damage control orthopedic surgery. Am J Surg. 2002;183(6):622–9.CrossRef

20.

Bruce B, Stone J. External fixation in pediatric trauma. Curr Orthop Pract. 2011;22(2):157–61. https://doi.org/10.1097/BCO.0b013e3182107f69.CrossRef

21.

Humphrey JA, Gillani S, Barry MJ. The role of external fixators in paediatric trauma. Acta Orthop Belg. 2015;81(3):363–7.PubMed

22.

Aronson J, Tursky EA. External fixation of femur fractures in children. J Pediatr Orthop. 1992;12(2):157–63.CrossRef

23.

Schalamon J, Petnehazy T. The management of traumatic fractures in children. Minerva Pediatr. 2009;61(2):185–92.PubMed

24.

Hurme T. Children’s limb fractures. Duodecim. 2015;131(5):457–63.PubMed

25.

Tolo VT. External fixation in multiply injured children. Orthop Clin N Am. 1990;21(2):393–400.

26.

Jafarpour S, Nassiri SJ, Bidari A, Chardoli M, Rahimi-Movaghar V. Principles of primary survey and resuscitation in cases of pediatric trauma. Acta Med Iran. 2015;53(4):242–5.PubMed

27.

MacKenzie EJ, Bosse MJ, Kellam JF, Burgess AR, Webb LX, Swiontkowski MF, et al. Factors influencing the decision to amputate or reconstruct after high-energy lower extremity trauma. J Trauma. 2002;52(4):641–9.PubMed

28.

Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C, et al. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg. 2007;246(3):491–9. https://doi.org/10.1097/SLA.0b013e3181485750 (discussion 9–501).CrossRefPubMedPubMedCentral

29.

Stahel PF, Heyde CE, Wyrwich W, Ertel W. Current concepts of polytrauma management: from ATLS to “damage control”. Orthopade. 2005;34(9):823–36. https://doi.org/10.1007/s00132-005-0842-5.CrossRefPubMed

30.

Waydhas C, Nast-Kolb D, Trupka A, Zettl R, Kick M, Wiesholler J, et al. Posttraumatic inflammatory response, secondary operations, and late multiple organ failure. J Trauma. 1996;40(4):624–30 (discussion 30–31).CrossRef

31.

Harwood PJ, Giannoudis PV, van Griensven M, Krettek C, Pape HC. Alterations in the systemic inflammatory response after early total care and damage control procedures for femoral shaft fracture in severely injured patients. J Trauma. 2005;58(3):446–52 (discussion 52–54).CrossRef

32.

Calkins CM, Bensard DD, Moore EE, McIntyre RC, Silliman CC, Biffl W, et al. The injured child is resistant to multiple organ failure: a different inflammatory response? J Trauma. 2002;53(6):1058–63. https://doi.org/10.1097/01.TA.0000025292.68353.59.CrossRefPubMed

33.

Proulx F, Joyal JS, Mariscalco MM, Leteurtre S, Leclerc F, Lacroix J. The pediatric multiple organ dysfunction syndrome. Pediatr Crit Care Med. 2009;10(1):12–22. https://doi.org/10.1097/PCC.0b013e31819370a9.CrossRefPubMed

34.

Husain B, Kuehne C, Waydhas C, Lewan U, Ose C, Nast-Kolb D, et al. Incidence and prognosis of organ failure in severely injured children and adult patients. Eur J Trauma Emerg Surg. 2006;32:548. https://doi.org/10.1007/s00068-006-5139-9.CrossRef

35.

Lefering R. Strategies for comparative analyses of registry data. Injury. 2014;45(Suppl 3):83–8. https://doi.org/10.1016/j.injury.2014.08.023.CrossRef

36.

Lefering R. TraumaRegister^® DGU—Annual Report 2015; 2015.

Titel: Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO—an analysis of 316 pediatric trauma patients from the TraumaRegister DGU®
verfasst von: Klemens Horst
Hagen Andruszkow
Christian David Weber
Miguel Pishnamaz
Matthias Knobe
Felix Marius Bläsius
Philipp Lichte
Rolf Lefering
Frank Hildebrand
Publikationsdatum: 13.02.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Trauma and Emergency Surgery / Ausgabe 5/2019
Print ISSN: 1863-9933
Elektronische ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-019-01092-7

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Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO—an analysis of 316 pediatric trauma patients from the TraumaRegister DGU^®