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Predictors of abdominal injury in children with pelvic fracture
S J Bond1, C S Gotschall, M R Eichelberger
1Department of Surgery, George Washington University Medical Center, Children's National Medical Center, Washington, DC 200100-2970.
Insights
Pediatric blunt trauma patients with pelvic fractures have a high risk of abdominal or genitourinary (GU) injury. Multiple pelvic fractures significantly predict associated abdominal/GU injuries in children.
Area of Science:
- Pediatric Trauma Surgery
- Emergency Medicine
- Radiology
Background:
- Blunt trauma in children can lead to severe injuries, including pelvic fractures.
- Pelvic fractures in pediatric patients are associated with significant morbidity and mortality.
- Identifying concomitant injuries is crucial for effective management.
Purpose of the Study:
- To determine the incidence of pelvic fractures in children admitted with blunt trauma.
- To identify predictors of associated abdominal or genitourinary (GU) injuries in pediatric pelvic fracture patients.
- To analyze the relationship between fracture patterns and the likelihood of abdominal/GU injury.
Main Methods:
- Retrospective analysis of 2,248 pediatric blunt trauma admissions over 48 months.
- Radiographic diagnosis of pelvic fractures.
- Contingency table analysis and stepwise logistic regression to identify injury predictors.
- Statistical analysis of fracture location and associated injuries.
Main Results:
- 54 children (2.4%) sustained pelvic fractures; 13 had abdominal/GU injuries.
- Multiple pelvic fractures (19% of cases) were strongly associated with abdominal/GU injury (80% incidence).
- Multiple pelvic fractures and unweighted Revised Trauma Score were the best predictors of abdominal/GU injury.
Conclusions:
- Pelvic fractures in pediatric blunt trauma patients necessitate thorough evaluation for abdominal/GU injuries.
- The presence of multiple pelvic fractures is a critical indicator for associated intra-abdominal or GU trauma.
- Early identification of these predictors can guide diagnostic and therapeutic strategies in pediatric trauma care.
Abstract:
During a 48-month period, 2,248 children (aged less than 15 years) were consecutively admitted to a regional pediatric trauma center with blunt trauma (ICD-9-CM code greater than or equal to 800). Fifty-four children (2.4%) had injury to the pelvic circle, as diagnosed by radiographic examination; 13 of these children had concomitant abdominal or genitourinary (GU) injury. Contingency table analysis and stepwise logistic regression were used to determine the best predictors of abdominal injury. The mean age of the children was 8.6 years. Eighty-nine percent of the injuries were motor-vehicle related (59% pedestrian; 30% crash occupant). Nine children (17%) required transfusions of packed red blood cells; 9 children (17%) required surgery. There were 6 deaths in this group, a mortality rate of 11.1%. The most common fracture sites in the pelvis were the pubic rami (59%), ilium or pelvic rim (17%), and the sacrum (6%). Ten children (19%) had multiple pelvic fractures. Location of fracture was strongly associated with the probability of abdominal injury: 80% of children with multiple pelvic fractures had concomitant abdominal or GU injury, compared with 33% with fracture of the ilium or pelvic rim, and 6% with isolated pubic fractures (p less than 0.001). The variables that best predicted abdominal or GU injury using a backward-elimination, stepwise logistic model were the presence of multiple pelvic fractures (p less than 0.002) and unweighted Revised Trauma Score (p less than 0.05); age of child, systolic blood pressure, respiration rate, Glasgow Coma Scale score, and mechanism of injury were not predictive.(ABSTRACT TRUNCATED AT 250 WORDS)