Guindani Nicola, Cheli Maurizio, Ferrari Daniela, Colombo Giovanna, Bonanomi Ezio, Chiodini Federico, De Pellegrin Maurizio
Orthopedics and Traumatology Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy.
Pediatric Surgery Unit, Regional Health Care and Social Agency Papa Giovanni XXIII, Regional Hub for the Pediatric Polytrauma, 24127 Bergamo, Lombardia, Italy.
Children (Basel). 2025 Sep 8;12(9):1194. doi: 10.3390/children12091194.
Pediatric polytrauma (PPT) and major trauma in pediatric patients (PMT) present unique challenges compared to adult trauma care due to distinct anatomical and physiological differences. PPT/PMT remains the leading cause of death in children, responsible for over 50% of pediatric deaths and 15% of pediatric hospital admissions due to its long-term effects. This single-institution study focuses on the initial management of PPT/PMT from an orthopedics and traumatology point of view. In the present study, data of PPT/PMT managed in one single institution, an academic level I pediatric trauma center, in patients <18 years of age, were analyzed over different periods. Over a 10-year period, diaphyseal femur fractures were analyzed as indicators of damage control (DCO) versus definitive treatment. Over a 4-year period (2021-2024), the associated lesions of PPT (head injuries, thoracic and abdominal lesions, spine lesions, major blood vessel lesions, and major musculoskeletal injury) were analyzed. Over a 1-year period (2019), the overall in-hospital mortality and admission rates in the pediatric intensive care unit were analyzed. In the 10-year period, among 298 diaphyseal femur fractures, 46/298 (15%) were classified as PPT in which DCO was performed according to age as follows: in the age-group 15-17 years 23/23 (100%) with temporary external fixation (ExFix); in the age group 12-14 years, 9/14 (64%) with ExFix and 5/14 (26%) and elastic stable intramedullary nails (ESINs); in the age group 5-11 years, 1/5 (20%) with ExFix and 4 with ESIN; in the age group 0-4 years, 2/4 (50%) with ESIN and 2/4 (50%) with a cast. In the 4-year period, PPT/PMTs were associated with 60% head injury, 25% thoracic lesion(s), 18% abdominal lesion(s), 16% spine injury, 5% lesion of a major blood vessel, and 30% major musculoskeletal injuries. In 2019, there were 193 patients admitted to the emergency room as PPT/PMT: 115 were ≤12 years old and 78 were >12 years old. On admission, 46% were admitted to the pediatric intensive care unit, and 65% were admitted to the department of traumatology as inpatients. The in-hospital mortality rate was 7%. In our institution, pediatric trauma is assessed using the Pediatric Trauma Score (PTS), and the workup follows the ATLS guidelines with a dedicated trauma team. The role of the orthopedic surgeon during the primary evaluation of PPT/PMT is to contribute to stopping bleeding and hemorrhagic shock. In PPT/PMT, DCO in adolescents is superimposable to adults, whilst in babies and children, DCO is still performed, but it is not a form of temporary external fixation.
与成人创伤护理相比，小儿多发伤（PPT）和小儿患者的严重创伤（PMT）由于明显的解剖学和生理学差异而带来独特的挑战。PPT/PMT仍然是儿童死亡的主要原因，由于其长期影响，导致超过50%的儿童死亡以及15%的儿童因伤住院。这项单机构研究从骨科和创伤学的角度关注PPT/PMT的初始管理。在本研究中，分析了在一个单一机构（一所学术一级小儿创伤中心）对18岁以下患者进行管理的PPT/PMT在不同时期的数据。在10年期间，分析了股骨干骨折作为损伤控制（DCO）与确定性治疗的指标。在4年期间（2021 - 2024年），分析了PPT的相关损伤（头部损伤、胸部和腹部损伤、脊柱损伤、主要血管损伤和主要肌肉骨骼损伤）。在1年期间（2019年），分析了小儿重症监护病房的总体住院死亡率和入院率。在10年期间，298例股骨干骨折中，46/298（15%）被归类为PPT，其中根据年龄进行DCO如下：在15 - 17岁年龄组，23/23（100%）采用临时外固定（ExFix）；在12 - 14岁年龄组，9/14（64%）采用ExFix，5/14（26%）采用弹性稳定髓内钉（ESINs）；在5 - 11岁年龄组，1/5（20%）采用ExFix，4例采用ESIN；在0 - 4岁年龄组，2/4（50%）采用ESIN，2/4（50%）采用石膏固定。在4年期间，PPT/PMT与60%的头部损伤、25%的胸部损伤、18%的腹部损伤、16%的脊柱损伤、5%的主要血管损伤和30%的主要肌肉骨骼损伤相关。2019年，有193例患者以PPT/PMT身份入住急诊室：115例年龄≤12岁，78例年龄>12岁。入院时，46%入住小儿重症监护病房，65%作为住院患者入住创伤科。住院死亡率为7%。在我们机构，使用小儿创伤评分（PTS）评估小儿创伤，检查遵循ATLS指南并由专门的创伤团队进行。骨科医生在PPT/PMT的初步评估中的作用是协助止血和治疗失血性休克。在PPT/PMT中，青少年的DCO与成人相似，而在婴儿和儿童中，仍进行DCO，但不是临时外固定的形式。
