Pelvic fractures in children: an exploration of practice patterns and patient outcomes.
Pelvic fractures in children represent a unique set of patients for several reasons. Pediatric pelvic fractures are relatively uncommon and the long-term consequences of these fractures and their associated injuries often have a substantial impact on these patients for the rest of their lives. There is significant controversy regarding the appropriate approach toward the management of these injuries. Nevertheless, there is substantial variability in the orthopaedic management of pediatric pelvic fractures, which warrants a closer investigation. A good starting point for addressing some of these issues is to explore the relationship between practice patterns and patient outcomes. More specifically, a study exploring the relationship between the type of centers that treat these unique fractures and patient outcomes can yield some insightful information. In an effort to address these issues, the authors used the National Pediatric Trauma Registry to conduct a retrospective analysis of this unique pediatric population. The main outcome of interest focused on mortality. With respect to patient information, the independent variables involved demographics (gender, age, race), type of injury (penetrating, blunt, crush), presence of head injury, injury severity indices (Injury Severity Score [ISS], Glasgow Coma Scale), and the Functional Independence Measure. After adjusting for confounding and interaction effects between these variables, only ISS and the type of hospital were determined to be significant in predicting survival.
Vitale
Michael G
MG
International Center for Health Outcomes and Innovation Research, College of Physicians and Surgeons, Columbia University and New York Presbyterian Hospital, New York, NY 10032, USA. mgv1@columbia.edu
Kessler
Michael W
MW
Choe
Julie C
JC
Hwang
Matthew W
MW
Tolo
Vernon T
VT
Skaggs
David L
DL
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications; D005260:Female; D050723:Fractures, Bone / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006769:Hospitals, General / Q000592:standards*; D006776:Hospitals, Pediatric / Q000592:standards*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D008297:Male; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010384:Pelvic Bones / Q000293:injuries*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies