Risk Factors and Timing of Fasciotomy for Isolated Pediatric Lower Extremity Trauma.

BackgroundPrevious single-center reports have demonstrated a longer time from traumatic leg injury to fasciotomy in pediatric trauma patients (PTPs) with compartment syndrome. We hypothesized most fasciotomies in isolated pediatric lower extremity trauma (LET) are delayed (6 hours from admission) and sought to investigate risk factors for pediatric fasciotomy.MethodsThe 2017-2020 TQIP database was queried for PTPs 17 years old with isolated injury to the leg. The primary outcome was fasciotomy. A multivariable logistic regression analysis was performed to identify associated risk factors for fasciotomy.ResultsFrom 97,217 PTPs, 358 (0.4%) underwent a fasciotomy, with a majority being delayed (60.3%); the median time to fasciotomy was 9.6 hours. Patients undergoing fasciotomy were older (median age 14 vs 12 years, < 0.001), had a higher rate of severe LET (4.9% vs 1.2%, < 0.001), and had tibial fracture (70.7% vs 27.6%, < 0.001). They also had increased rates of in-hospital complications (14.2% vs 0.6%, < 0.001), limb loss (1.1% vs <0.1%, < 0.001), and longer median length of stay (LOS) (5 vs 2 days, < 0.001). The most injured vessel in those undergoing fasciotomy was the popliteal artery (9.9%). Independent risk factors associated with fasciotomy included injuries to the popliteal vein (OR 30.72, CI 11.06-85.29, < 0.001), femoral vein (OR 18.19, CI 6.40-51.69, < 0.001), and popliteal artery (OR 13.74, CI 8.45-22.34, < 0.001) and tibial fracture (OR 7.46, CI 5.57-10.00, < 0.001).DiscussionMost fasciotomies were delayed for PTPs with isolated lower extremity injury. Popliteal vein injury increases the risk for fasciotomy 30-fold. Patients undergoing fasciotomy tend to have more complications and longer LOS.