Trends and Associated Factors of Pediatric Acute Compartment Syndrome From 2015 to 2024: A Large, Retrospective Cohort Analysis.

Background: Acute compartment syndrome (ACS) is a relatively rare complication in pediatric patients which can result in significant morbidity and mortality. Although studies with limited patient cohorts exist, knowledge gaps remain regarding the epidemiology and associated clinical factors with ACS. This study utilized a large database to investigate demographic variables, national trends, and clinical factors associated with pediatric patients undergoing fasciotomies for ACS. Methods: The TriNetX US Collaborative Network database was queried using International Classification of Disease, 10th Revision and Current Procedural Terminology codes to identify patients aged 18 years and younger undergoing fasciotomy for ACS between 2015 and 2024. Patients were further stratified based on upper or lower extremity compartment syndrome. The primary outcome was the incidence proportion (IP) of pediatric ACS requiring fasciotomy. Cohort characteristics were collected including age, sex, race, body mass index (BMI), comorbidities, orthopaedic complications, compartment syndrome location, and geographic distribution of patients. Results: A total of 28,532,251 patients aged 18 years and younger were identified, of which 1,345 patients underwent fasciotomies for ACS. The mean age was 14.7 ± 4.0 years with a mean BMI of 24.7 ± 5.9. A majority of the cohort were male (59%) and White (62%). Fewer than 10% of patients had pre-existing comorbidities. The most common associated fracture for pediatric ACS was tibial shaft fracture (19%). The most common associated fracture characteristics were open fractures (27%) and necessity for surgical fixation of fractures (28%). The most common medical complications were inpatient readmission at 30 days (17%) and acute kidney injury at 30 days (6%). The rate of mortality was 1% at 7 days and 2% at 30 days. The IP within the TriNetX pediatric population in 2024 was approximately 17 cases per one million patients compared to 14 cases per million in 2015 ( Conclusions: The incidence of pediatric ACS within the TriNetX cohort has remained relatively consistent since 2015, with most cases occurring in open, tibial shaft fractures. Lower extremity injuries comprised a vast majority of cases. Future studies are needed to further delineate factors associated with an ACS presentation. Key Concepts: (1)The incidence proportion of pediatric acute compartment syndrome has remained relatively consistent since 2015, with most cases occurring in lower extremity trauma, particularly open, tibial shaft fractures.(2)Although prevalence have increased over the past decade, this likely reflects better detection, not rising disease.(3)While this study explores national trends and epidemiologic patterns, future studies are needed to explore causal links for specific factors contributing to pediatric acute compartment syndrome. Level of Evidence: III, Retrospective cohort study.