PEDIATRIC AMPUTATION INJURIES - ETIOLOGY, COST, AND OUTCOME

Objective: To provide a comprehensive profile of amputation injuries i n children and adolescents. Design: A retrospective case series. Mater ials and Methods: All patients 18 years old or less, admitted to the r egional Level I trauma center hospital with a traumatic amputation inj ury over a 10-year period (74 patients, 77 extremities) were included in the study, Etiology and mechanism of injury, length of hospital sta y, number of surgeries and procedures, presence of infection, final ou tcome of injury (amputation vs. salvage), anatomic location of final o utcome, and total charges were recorded for each patient. Measurements and Main Results: There were 47 injuries to the upper extremity, and 30 to the lower extremity, The average length of stay was 11.3 days, w ith a mean of 4.3 procedures in 2.3 surgeries and average charges of $ 22,015. Twenty-two percent of the injuries were caused by power lawn m owers; all of these patients had amputations. Motor vehicle related cr ashes accounted for 16% of all injuries; 77% of these ultimately had a mputations. Gunshot wounds had the highest mean length of hospital sta y, surgery days, number of procedures, and charges. Out of 32 extremit ies that were revascularized for attempted salvage, 27 were successful (84%), all in the upper extremity, and all but one were digits. Concl usions: Injuries caused by a sharp mechanism with a smaller area of in volvement are more Likely to be successfully salvaged with revasculari zation, regardless of ischemic time. Long-term follow-up is needed to evaluate final functional and psychosocial outcome. Lawn mowers repres ent a serious hazard to children, and should be addressed through chan ges in engineering and parent education.