Factors predictive of immobilization complications in pediatric polytrauma

Objectives: To determine in a cohort of children with polytrauma which variables are predictive of the development of complications related to immobilization. Design: A retrospective study of children with polytrauma and at least one major musculoskeletal injury. A stepwise forward logistic regression analysis was used to determine variables predictive of complications related to immobilization. Participants: Ninety-three children with polytrauma were studied; motor vehicle incidents accounted for 80 percent of the injuries. The average age was 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 died. Results: Two variables were predictive of complications related to immobilization: age and MISS score, Complications related to immobilization were positively associated with being older than seven years of age (p = 0.027; odds 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 interval 2.2, 89.1). Timing of surgery showed a trend (p = 0.097) but did not reach statistical significance. Conclusions: Complications of immobilization in children with polytrauma are associated with age greater than seven years and a MISS score greater than forty. Further study is needed to evaluate the effect of early fracture stabilization. Timing of osteosynthesis showed a trend but did not reach statistical significance in this study.