Background: Evaluate, by radiographic analysis, tibial growth after an intraosseous infusion (IOI) in a pediatric population.
Methods: We performed a prospective simple blind study, between January 1, 1994, and July 1, 2001, which included pediatric patients who needed an intraosseous trocar in emergency situations. During the follow-up, roentgenographs were performed. On each radiologic view, different measurements were carried out: anterior and lateral tibial length, anterior and lateral width at 2 diaphyseal levels. We compared the anterior length values to those published in the Anderson et al tables. When only one tibia was punctured, the mean measurements were compared with the control leg measurements using a paired t test.
Results: The initial population included 78 patients. Of these 78 subjects, 42 died, 10 families could not be contacted, and one refused to participate. Two children were excluded because they had other conditions that could influence tibial growth. The study included 23 children. The puncture site was the proximal tibia. The mean age was 18.6 months at the time of IOI, the mean time of infusion was 5 hours, and the mean perfused volume was 225 mL. The mean radiologic follow-up time was 29.2 months. When compared with the Anderson et al tables, all the anterior length values were within the 95% confidence interval. For the other measurements, the statistical analysis showed no significant difference between punctured and control legs.
Conclusion: There is no long-term effect on tibial growth after an IOI when the IO trocar is properly placed.
Intraosseous infusion is a widely accepted emergency alternative to intravenous access in children. However, growth plate injury and growth disturbance is a potential risk. A small number of published clinical studies support the safety of this access, 1-4 but the studied populations were small with a follow-up time of younger than 2 years. The aim of this study was to demonstrate that tibial growth is not retarded following IOI when the procedure is correctly performed.