Risk factors for developing acute compartment syndrome in the pediatric population: a systematic review and meta-analysis.

PURPOSE: Acute compartment syndrome (ACS) is often difficult to diagnose in pediatric patients due to their erratic symptomatology. Therefore, it is of paramount importance to identify at-risk patients to facilitate a prompt diagnosis. This study aims to identify risk factors for the development of ACS in the pediatric population.

METHODS: We included studies comprised of pediatric patients with traumatic ACS. We excluded studies evaluating compartment syndrome secondary to exertion, vascular insult, abdominal processes, burns, and snake bites. Heterogeneity was addressed by subgroup analysis, and whenever it remained significant, we utilized a random-effects meta-analysis for data pooling. The protocol has been registered at PROSPERO (ID = CRD42019126603).

RESULTS: We included nine studies with 380,411 patients, of which 1144 patients were diagnosed with traumatic ACS. The average age was 10 years old, and 67% of patients were male. Factors that were significantly associated with ACS were: open radius/ulna fractures (OR 3.56 CI 1.52-8.33, p = 0.003), high-energy trauma (OR 3.51 CI 1.71-7.21, p = 0.001), humerus fractures occurring concurrently with forearm fractures (OR 3.49 CI 1.87-6.52, p < 0.001), open tibia fractures (OR 2.29 CI 1.47-3.55, p < 0.001), and male gender (OR 2.06 CI 1.70-2.51, p < 0.001).

CONCLUSION: In the present study, open fractures, high-energy trauma, concurrent humerus and forearm fractures, and male gender significantly increased the risk of developing ACS in the pediatric population. Clinicians should raise their suspicion for ACS when one or multiple of these factors are present in the right clinical context.

TYPE OF STUDY: Systematic review and meta-analysis.

LEVEL OF EVIDENCE: III.