Factors predictive of immobilization complications in pediatric polytrauma.
OBJECTIVE
To determine in a cohort of children with polytrauma which variables are predictive of the development of complications related to immobilization.


METHODS
A retrospective study of children with polytrauma and at least one major musculoskeletal injury. A stepwise forward logistic regression analysis was used to determine variables predictive of complications related to immobilization.


METHODS
Ninety-three children with polytrauma were studied; motor vehicle incidents accounted for 80 percent of the injuries. The average age was 8.0 +/- 4.1 years. There were 152 fractures in the ninety-three children. The average Modified Injury Severity Scale (MISS) was 24.5 +/- 13.6. There were thirty-five complications in twenty-two children, and four children died.


RESULTS
Two variables were predictive of complications related to immobilization: age and MISS score. Complications related to immobilization were positively associated with being older than seven years of age (p = 0.027; odds ratio = 9.5; 95 percent confidence interval 1.4, 64.9) and having a MISS score greater than forty (p = 0.005; OR = 14.1; 95 percent confidence interval 2.2, 89.1). Timing of surgery showed a trend (p = 0.097) but did not reach statistical significance.


CONCLUSIONS
Complications of immobilization in children with polytrauma are associated with age greater than seven years and a MISS score greater than forty. Further study is needed to evaluate the effect of early fracture stabilization. Timing of osteosynthesis showed a trend but did not reach statistical significance in this study.
Loder
R T
RT
Section of Orthopaedic Surgery, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, Michigan, U.S.A.
Gullahorn
L J
LJ
Yian
E H
EH
Ferrick
M R
MR
Raskas
D S
DS
Greenfield
M L
ML
D015998:Abbreviated Injury Scale; D000063:Accidents, Traffic; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D006801:Humans; D007103:Immobilization / Q000009:adverse effects*; D007223:Infant; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D009104:Multiple Trauma / Q000145:classification* / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017678:Sex Distribution