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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®

  • Klemens HorstEmail author
  • Hagen Andruszkow
  • Christian David Weber
  • Miguel Pishnamaz
  • Matthias Knobe
  • Felix Marius Bläsius
  • Philipp Lichte
  • Rolf Lefering
  • Frank Hildebrand
Original Article

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 AISExtremity ≥ 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, AISExtremity ≥ 3 and AISExtremity ≥ 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.

Keywords

ETC DCO Children Severely injured 

Abbreviations

ACCP

American College of Chest Physicians

AIS

Abbreviated injury score

CNS

Central nervous system

CT

Computer tomography

DCO

Damage control orthopedic surgery

ESIN

Elastic intramedullary nailing

ETC

Early total care

ICU

Intensive care unit

ICM

Intensive care medicine

MOF

Multi organ failure

MODS

Multi organ dysfunction syndrome

ISS

Injury Severity Score

SOFA

Sequential Organ Failure Assessment Score

TR-DGU

TraumaRegister DGU®

Notes

Acknowledgements

The article was proofread by Proof-Reading-Service.com, Devonshire Business Centre, Works Road, Letchworth Garden City, SG6 1GJ, United Kingdom. Furthermore, the authors would like to thank the internal review of the TR-DGU for their substantial contribution.

Author contributions

Conceived and designed the study: KH, HA, CDW, MP, PL, FMB, MK, RL, and FH. Performed the study: KH, HA, and FMB. Analyzed the data: KH, CDW, MP, PL, and FH. Wrote the paper: KH, CDW, and MP. Contributed substantially to manuscript revision: all authors. Read and approved the final manuscript for publication: all authors.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

Not applicable.

Informed consent

The TR-DGU gave permission for publication. All authors read and approved the final manuscript and gave permission for publication.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Klemens Horst
    • 1
    Email author
  • Hagen Andruszkow
    • 1
  • Christian David Weber
    • 1
  • Miguel Pishnamaz
    • 1
  • Matthias Knobe
    • 1
  • Felix Marius Bläsius
    • 1
  • Philipp Lichte
    • 1
  • Rolf Lefering
    • 2
  • Frank Hildebrand
    • 1
  1. 1.Department of Trauma and Reconstructive SurgeryRWTH Aachen UniversityAachenGermany
  2. 2.IFOM, Institute for Research in Operative Medicine, Faculty of HealthUniversity Witten/HerdeckeCologneGermany

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