David A Stewart1, Christopher J Coombs, H Kerr Graham. 1. Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Parkville, Melbourne, Australia ; University of Melbourne, Parkville, Melbourne, Australia ; 3W Clinical Offices, Royal Children's Hospital, Flemington Road, Parkville, VIC 3052 Australia.
Abstract
PURPOSE: Severe lower extremity trauma presents challenges in decision-making in terms of reconstruction or amputation. While injury severity scores have been developed to aid decision-making in adults, evaluation of their use in children is limited. METHODS: Children presenting with severe lower limb trauma from 2000 to 2010 in a major trauma centre were identified from a trauma registry. Records were reviewed for details of the injury, surgical intervention, amputation and scores for the Mangled Extremity Severity Score, Limb Salvage Index, Predictive Salvage Index, Nerve injury, Ischaemia, Soft tissue injury, Skeletal injury, Shock, Age System and the Hanover Fracture Scale 1998. RESULTS: Twenty children (average age 8.7 years) were eligible for inclusion. There were three primary amputations and no secondary amputations. All of the scoring systems had poor specificity and would have recommended amputation in several limbs that were successfully reconstructed. CONCLUSIONS: Currently available injury severity scores behave differently in children and adults. In their current format, these scores should not be used as an absolute indication for early amputation in children.
PURPOSE: Severe lower extremity trauma presents challenges in decision-making in terms of reconstruction or amputation. While injury severity scores have been developed to aid decision-making in adults, evaluation of their use in children is limited. METHODS:Children presenting with severe lower limb trauma from 2000 to 2010 in a major trauma centre were identified from a trauma registry. Records were reviewed for details of the injury, surgical intervention, amputation and scores for the Mangled Extremity Severity Score, Limb Salvage Index, Predictive Salvage Index, Nerve injury, Ischaemia, Soft tissue injury, Skeletal injury, Shock, Age System and the Hanover Fracture Scale 1998. RESULTS: Twenty children (average age 8.7 years) were eligible for inclusion. There were three primary amputations and no secondary amputations. All of the scoring systems had poor specificity and would have recommended amputation in several limbs that were successfully reconstructed. CONCLUSIONS: Currently available injury severity scores behave differently in children and adults. In their current format, these scores should not be used as an absolute indication for early amputation in children.
Authors: Michael J Bosse; Ellen J MacKenzie; James F Kellam; Andrew R Burgess; Lawrence X Webb; Marc F Swiontkowski; Roy W Sanders; Alan L Jones; Mark P McAndrew; Brendan M Patterson; Melissa L McCarthy; Thomas G Travison; Renan C Castillo Journal: N Engl J Med Date: 2002-12-12 Impact factor: 91.245
Authors: Ellen J MacKenzie; Michael J Bosse; Andrew N Pollak; Lawrence X Webb; Marc F Swiontkowski; James F Kellam; Douglas G Smith; Roy W Sanders; Alan L Jones; Adam J Starr; Mark P McAndrew; Brendan M Patterson; Andrew R Burgess; Renan C Castillo Journal: J Bone Joint Surg Am Date: 2005-08 Impact factor: 5.284
Authors: E J MacKenzie; M J Bosse; J F Kellam; A R Burgess; L X Webb; M F Swiontkowski; R W Sanders; A L Jones; M P McAndrew; T M Patterson; M L McCarthy Journal: J Orthop Trauma Date: 2000 Sep-Oct Impact factor: 2.512
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