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Multisystemic involvement of post-traumatic fat embolism at a Pediatric Trauma Center: a clinical series and literature review

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Abstract

Post-traumatic fat embolism syndrome (FES) is a severe complication consequent to bone fractures. The authors describe its clinical features and management in a population of teenagers by detailing demographics, organ involvement, laboratory, and imaging findings, as well as outcome. Moreover, a systematic review of pediatric published case reports of post-traumatic FES is provided. First, a series of eight episodes of post-traumatic FES that occurred in seven patients (median age 16.0 years, IQR 16.0–17.5) admitted to a pediatric intensive care unit (PICU) in an 8-year period was analyzed through a retrospective chart review. Secondly, a systematic research was performed on PUBMED database. Trauma patients ≤ 18 years without comorbidities in a 20-year period (2002–2022) were included in the review. Neurological impairment was present in five out of seven patients, and a patent foramen ovale was found in four cases. Hemodynamic instability requiring vasoactive drugs was recorded in four patients. A severe form of acute respiratory distress syndrome (ARDS) occurred in five cases, with the evidence of hemorrhagic alveolitis in three of them. In the literature review, eighteen cases were examined. Most cases refer to adolescents (median age 17.0 years). More than half of patients experienced two or more long bone fractures (median: 2 fractures). Both respiratory and neurological impairment were common (77.8% and 83.3%, respectively). 88.9% of patients underwent invasive mechanical ventilation and 33.3% of them required vasoactive drugs support. Neurological sequelae were reported in 22.2% of patients.

Conclusion: Post-traumatic FES is an uncommon multi-faceted condition even in pediatric trauma patients, requiring a high level of suspicion. Prognosis of patients who receive prompt support in an intensive care setting is generally favorable.

What is Known:

•Post-traumatic fat embolism syndrome is a severe condition complicating long bone or pelvic fractures.

•Little is known about clinical features and management in pediatric age.

What is New:

•Post-traumatic fat embolism syndrome can cause multiple organ failure, often requiring an intensive care management.

•Prompt supportive care contributes to a favorable prognosis.

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Data availability

The data that support the findings of this study are available from the corresponding author, [EP], upon request.

Abbreviations

ARDS:

Acute respiratory distress syndrome

CPC:

Cerebral performance category

CT:

Computerized thomography

FES:

Fat embolism syndrome

GCS:

Glasgow coma scale

HMG-CoA:

3-Hydroxy-3-methylglutaryl-coenzyme A

MRI:

Magnetic resonance imaging

PICU:

Pediatric intensive care unit

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Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit and Pediatric Trauma Center, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Largo A. Gemelli 8, Rome, 00168, Italy

    Marco Piastra, Enzo Picconi, Tony Christian Morena, Vittoria Ferrari, Federico Visconti, Daniele De Luca & Giorgio Conti

  2. Institute of Anesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy

    Marco Piastra, Anselmo Caricato & Giorgio Conti

  3. Neurological Intensive Care Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy

    Camilla Gelormini & Anselmo Caricato

  4. Surgical Intensive Care Unit, University Hospital of Padua, Padua, Italy

    Federico Visconti

  5. Neonatal and Pediatric Intensive Care Unit, Paris Sud University Antoine-Béclère Hospital, Paris, France

    Daniele De Luca

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  1. Marco Piastra
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  2. Enzo Picconi
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Contributions

Marco Piastra conceived the study, collected, and interpreted the case series data and performed the statistical analysis. Enzo Picconi contributed to data collection, gave important contribute to paper preparation, and drafted the manuscript. Tony Christian Morena and Vittoria Ferrari were involved in manuscript preparation. Camilla Gelormini and Anselmo Caricato were responsible for patient care and contributed to data collection. Daniele De Luca, Federico Visconti, and Giorgio Conti contributed important intellectual content to the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Enzo Picconi.

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Ethics approval

This study was approved by the institutional review board (Prot. 30870/19) on September 12, 2019, at Fondazione Policlinico Universitario “A. Gemelli” IRCCS – Rome, Italy.

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The authors declare no competing interests.

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Communicated by Piet Leroy.

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Piastra, M., Picconi, E., Morena, T.C. et al. Multisystemic involvement of post-traumatic fat embolism at a Pediatric Trauma Center: a clinical series and literature review. Eur J Pediatr 182, 1811–1821 (2023). https://doi.org/10.1007/s00431-023-04869-6

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