(1766) Traumatic and Nontraumatic Compartment Syndrome in Children: A National Database Study in the U.S

Introduction: Compartment syndrome (CS) is an uncommon but serious condition in the pediatric population and prompt recognition and treatment are critical for successful outcomes. Our study aimed to evaluate the demographics, complications, outcomes, and mortality in hospitalized children with both traumatic (TCS) and non-traumatic compartment syndromes (NTCS).

Methods: A retrospective, cross-sectional analysis of Kids’ Inpatient Database 2016 and 2019 was performed excluding neonates. CS diagnosis, procedures, and complications were identified using ICD 9 and 10 codes. Children with TCS and NTCS were compared using the chi-square test.

Results: Of 4,436,810 hospital discharges, compartment syndrome was documented in 2,792 (6.3/10,000 discharges) children. TCS was present in 65.5% and NTCS in 34.5%. The peak age of TCS was in adolescents, while NTCS showed a bimodal age distribution with peaks in 1-4 years and adolescents. The anatomical locations of CS include the lower extremity (LE) in 44.5%, the abdomen in 29.4%, the upper extremity (UE) in 6.6%, and other regions in 3.5% of cases. LE (50.4%) was most frequently involved in TCS (p < 0.001), whereas abdominal CS (52%) in NTCS (p < 0.001). The frequency of complications varied between TCS and NTCS, as well as the anatomical location of CS. Acute kidney injury (AKI) was common in abdominal CS (53.6%) and occurred more often in NTCS than TCS (43.2% vs 16%) (p < 0.001). Rhabdomyolysis occurred predominantly in NTCS than TCS (13.1% vs 7%; p< 0.001) and in CS in LE (13.2%). Invasive mechanical ventilation, septic shock, cardiac arrest, extracorporeal membrane oxygenation (ECMO), hemodialysis and vasopressor requirement were reported more commonly in abdominal CS when compared to other regions. Fasciotomy was done in 18.2% of children with CS with a higher rate in TCS versus NTCS (OR: 2.33, p< 0.001). The mortality rate was lower in TCS (10.2%) compared to NTCS (27.4%) (OR:0.3, p< 0.001). The highest mortality (43.3%) was reported in abdominal CS of non-traumatic etiology.

Conclusions: In children, TCS occurs more often than NTCS. LE is the most commonly involved location in CS. However, abdominal compartment syndrome is associated with higher rates of complications and mortality. We are presenting the national prevalence of CS in children in the US.