Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO—an analysis of 316 pediatric trauma patients from the TraumaRegister DGU®
External fixation within the damage control concept in unstable multiple trauma patients is widely accepted. Literature about its usage in the pediatric trauma population, however, is rare. The aim of the present study was to elucidate the factors associated with the application of external fixation in the severely injured child.
Patients with severe trauma aged 0–54 years documented in the TraumaRegister DGU® were included in this study. Demographic data, pattern of injury, injury severity, use of the damage control orthopedics (DCO) or early total care (ETC) concept, duration of mechanical ventilation, intensive care stay, and total hospital stay as well as the occurrence of complications and mortality were evaluated. Statistical evaluation was performed using SPSS (Version 21.0.0) using Chi square tests and linear regression models.
While injury severity was comparable between children and adults, type of accident and injury patterns showed significant differences, Overall, the majority of surgical fracture stabilization in AISExtremity ≥ 3 injuries followed the DCO concept in adults (60.3%) and the ETC protocol in children (49.4%). Conservative treatment was chosen for only 11.6% of all children and 9.6% of all adults. An increasing injury severity, AISExtremity ≥ 3 and AISExtremity ≥ 3 in ≥ 2 body regions, and a more advanced age were found to be independent factors in the use of the DCO concept in children.
Use of external fixation increases with age and plays a minor role in the very young trauma population. However, this does not produce a difference in outcome between children and adults.
KeywordsETC DCO Children Severely injured
American College of Chest Physicians
Abbreviated injury score
Central nervous system
Damage control orthopedic surgery
Elastic intramedullary nailing
Early total care
Intensive care unit
Intensive care medicine
Multi organ failure
Multi organ dysfunction syndrome
Injury Severity Score
Sequential Organ Failure Assessment Score
The article was proofread by Proof-Reading-Service.com, Devonshire Business Centre, Works Road, Letchworth Garden City, SG6 1GJ, United Kingdom. Furthermore, the authors would like to thank the internal review of the TR-DGU for their substantial contribution.
Conceived and designed the study: KH, HA, CDW, MP, PL, FMB, MK, RL, and FH. Performed the study: KH, HA, and FMB. Analyzed the data: KH, CDW, MP, PL, and FH. Wrote the paper: KH, CDW, and MP. Contributed substantially to manuscript revision: all authors. Read and approved the final manuscript for publication: all authors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The TR-DGU gave permission for publication. All authors read and approved the final manuscript and gave permission for publication.
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