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Identifier 000447840
Title Αναδρομική μελέτη κακώσεων άκρων πυέλου και σπονδυλικής στήλης σε παιδιά και νέους : Επιδημιολογικά δεδομένα και δείκτες έκβασης
Alternative Title Retrospective study of limb pelvis and spine injuries in children and youth
Author Μπαρμπαγαδάκη, Σοφία
Thesis advisor Ηλία, Σταυρούλα
Reviewer Δημητρίου Ροζαλία
Μπριασούλης, Γεώργιος
Ραϊσάκη, Μαρία
Abstract Introduction: Skeletal injuries account for 10% -15% of all injuries in children. Αlthough spinal injuries are relatively rare in paediatric patients, they have a very high mortality rate compared to other injuries. Cervical spine is most commonly affected accountig for 1%-2% with a mortality rate from 16% -40% and a significant proportion of neurological deficits over 60%. Clinical decision tools are commonly used to guide imaging decisions in cervical spine injury assessment. The A.P.L.S. (Advanced Pediatric Life Support), N.E.X.U.S. (National Emergency X-radiography Utilization Study and Canadian C-spine Rules (CC-R) / NICE (National Institute for Health and Care Excellence) are used as a guide for clinical decisionmaking on cervical spine imaging despite limited diagnostic accuracy for their use in paediatric populations. Pelvis injuries are rare accounting for 1-2% of all paediatric injuries. Due to close proximity to other important organs and structures, pelvic injuries could be life threatening. Mortality rate is 5-6.3% and is associated with other co-existing injuries (head, liver and spleen injuries). Limb injuries are exceptionally common, occuring mainly after falls , car accidents, during sports activities or even in cases of abuse. Objective: The aim of this retrospective study is to determine the spinal, pelvic and limb injuries in children and youth admitted in Paediatric Surgery Clinic and in Paediatric Intensive Care Unit at the University Hospital of Heraklion in a 7-year period. Demographic characteristics, incidence, mechamisms of injuries pattern of skeletal and nonskeletal injuries, assossiated injuries ,comllications and outcomes were evaluated. In addition, clinical decision tools A.P.L.S., N.E.X.U.S. and Canadian C-spine Rules / N.I.C.E. for the necesity of performig imaging were estimated. Methods: This is a retrospective, study which was conducted in Paediatric Surgery Clinic and in Paediatric Intensive Care Unit at the University Hospital of Heraklion concerning spinal, pelvis and limb injuries in children and youth in a 7- year period (2014-2020). According to our inclusion criteria, patients with complete sets of collected data and who were younger the age 18 with associated injuries of head ,abdomen and thorax were finally enrolled in this investigation. Collected data included age, gender, mechanism of injury, pattern of injury, associated injuries, nonsurgical and surgical treatment, functional outcome and mortality rate of the patients. Furthermore, clinical findings, radiologic assessment of C-spine with clinical decision tools A.P.L.S., N.E.X.U.S. and Canadian C-spine Rules / N.I.C.E. were evaluated. Results: 823 patients were studied, of which 582 (70.7%) were boys and 241 (29.3%) were girls. 784 (95.7%) were admitted in the Pediatric Surgery Clinic, and 36 (4.3%) in the P. I..C.U. The mean age was 8 ± 3.8 years and differed significantly between the sexes (boys 8.4 ± 3.9 vs. girls 7 ± 3.7 years, p <0.001). The most common types of injuries were falls (55.9%) and road accidents (28.7%). Mass transfusion protocol was activated in 6 patients (1%), while associated head injuries were found in 337 (40.9%) children and nonsurgical treatment in 95.5%. The duration of hospitalization was 2 days (IQR 1-4). Children victims of road accidents, children after falls from a significant height and multiple injuries of all etiologies were treated in P.I.C.U. (p <0.001). The duration of hospitalization in the P.I.C.U. was 8 days (IQR 4-11). In total, 2 (0.2%) children died, 12 (1.5%) had a neurological deficit, while 98.3% (N = 809) showed complete cure or improvement. The types of pelvic injuries were mild, immobilization occurred in 43 (5.2%) cases, and imaging was performed in 170 (20.6%) patients (17.4% radiographs, 3.3% CT). The radiological findings mainly concerned pelvic fractures that were treated conservatively. Upper limb injuries were 446 (56.5%), 45.3% underwent surgical operation and lower limb injuries were 330 (40.1%), 36% underwent surgical operation. 272 spinal injuries were reported, from which N=86 (31,6%) concerned the cervical spine ,N = 22 (12.1%) concerned thoracic spine, N = 9, (3.3%) concerned lumbar spine, N =1, (0.4%) concerned sacral spine The combinated spinal injuries were N = 143, (52.6%). The spinal imaging performed according to the A.P.L.S. criteria at 80.1%, without being affected by age distribution or type of injury, in contrast to the N.I.C.E. criteria where the agreement rate was 63.6%. Cervical spine imaging performed was in accordance with the A.P.L.S .criteria at 88.9%, without being affected by age distribution or type of injury, in contrast to the N.E.X.U.S. criteria where the agreement rate was 66.5%. Conclusions: The majority of children with traumatic skeletal injuries who were admitted in hospital were boys, which had upper and lower limb fractures, and had an excellent clinical outcome. Children and adolescents with severe trauma and associated injuries were admitted in P.I.C.U.. They had a longer stay duration and increased mortality. Spinal injuries were relatively rare and of minor severity. The A.P.L.S. spine and cervical spine imaging criteria showed better agreement and compliance than the N.I.C.E. and N.E.X.U.S. criteria, respectively. The perfectly adapted imaging A.P.L.S. criteria for the clearance of the cervical spine in children have a better compliance index, so that missing cervical spine injuries that can affect the patient outcome to be avoided and at the same time uneccessary imaging be reduced.
Language Greek
Subject Cervical spine
Upper limb
Αυχενική μοίρα
Πύελος
Πύελος
Issue date 2022-03-30
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
Permanent Link https://elocus.lib.uoc.gr//dlib/7/d/6/metadata-dlib-1651737095-333110-3065.tkl Bookmark and Share
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