Factors predictive of immobilization complications in pediatric polytrauma

Objectives: To determine in a cohort of children with polytrauma which vari ables are predictive of the development of complications related to immobil ization. Design: A retrospective study of children with polytrauma and at least one major musculoskeletal injury. A stepwise forward logistic regression analys is was used to determine variables predictive of complications related to i mmobilization. Participants: Ninety-three children with polytrauma were studied; motor veh icle incidents accounted for 80 percent of the injuries. The average age wa s 8.0 +/- 3.1 years. There were 152 fractures in the ninety-three children. The average Modified Injury Severity Scale (MISS) was 24.5 +/- 13.6. There were thirty-five complications in twenty-two children, and four children d ied. Results: Two variables were predictive of complications related to immobili zation: age and MISS score, Complications related to immobilization were po sitively associated with being older than seven years of age (p = 0.027; od ds ratio = 9.5; 95 percent confidence interval 1.4, 64.9) and having a MISS score greater than forty (p = 0.005; OR = 14.1; 95 percent confidence inte rval 2.2, 89.1). Timing of surgery showed a trend (p = 0.097) but did not r each statistical significance. Conclusions: Complications of immobilization in children with polytrauma ar e associated with age greater than seven years and a MISS score greater tha n forty. Further study is needed to evaluate the effect of early fracture s tabilization. Timing of osteosynthesis showed a trend but did not reach sta tistical significance in this study.