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Pelvic Fractures in Paediatric Polytrauma Patients: Classification, Concomitant Injuries and Early Mortality
Theodoros H Tosounidis1, Hassaan Sheikh1, Peter V Giannoudis1
1Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds and Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, UK.
Insights
In children with pelvic fractures and polytrauma, severe head injuries and high Injury Severity Scores (ISS) are linked to mortality. These young patients often have associated spine and chest trauma, but hemorrhage from pelvic injuries is uncommon.
Area of Science:
- Pediatric Trauma Surgery
- Orthopedic Traumatology
- Emergency Medicine
Background:
- Polytrauma in children presents unique challenges.
- Pelvic fractures in pediatric polytrauma patients require careful evaluation.
- Understanding associated injuries is crucial for management.
Purpose of the Study:
- To characterize pediatric polytrauma patients with pelvic fractures.
- To identify factors associated with mortality and outcomes.
- To analyze concomitant injuries in this cohort.
Main Methods:
- Retrospective review of 49 pediatric polytrauma patients with pelvic fractures (ISS ≥ 16).
- Analysis of Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), and pelvic ring injury type (AO/OTA).
- Correlation of outcomes (mortality, transfusion, ICU stay) with injury characteristics.
Main Results:
- Mean ISS was 31.4; Type B pelvic injuries were most common (55.1%).
- Head and face trauma occurred in 67.3%; 12.2% required transfusion.
- Five mortalities (10.2%) occurred, all with associated head trauma; mean hospital stay was 23.9 days.
Conclusions:
- Severe head injury and high ISS significantly predict mortality in pediatric polytrauma with pelvic fractures.
- Concomitant spine and chest injuries are frequent.
- Hemorrhage from pelvic fractures is rare; severe head injuries correlate with longer ICU stays.
Purpose Of This Study:
To review the characteristics, concomitant injuries and mortality in children with polytrauma and associated pelvic fractures treated in a Level-I Trauma Centre.
Materials And Methods:
Between December 2003 and November 2013, 49 children with an Injury Severity Score (ISS) of 16 or greater and a pelvic fracture met the inclusion criteria and were evaluated. The mortality, transfusion requirements and length of intensive care unit stay were correlated with the ISS, Abbreviated Injury Scale, concomitant limb and spine fractures, and type of pelvic ring injury (AO/OTA classification).
Results:
The mean ISS at presentation was 31.4 (range 16 to 57). 19 (38.7%) patients sustained a Type A, 27 (55.1%) a Type B and 3 (6.2%) a Type C injury. Head and face trauma was present in 33 (67.3%) cases. Blood transfusion during the resuscitation process was necessitated in six (12.2%) patients. Thirty-eight (77.5%) patients were managed non-operatively for their pelvic injuries. The mean duration of hospital stay was 23.9 days (range 1 to 146 days). In this cohort of polytrauma paediatric patients there were five (10.2%) mortalities (all suffered an associated head trauma ) within 30 days from the initial injury.
Conclusion:
Severe head injury and a high ISS are significantly associated with mortality in children with pelvic fractures. These patients have a high incidence of concomitant spine and chest injuries Hemorrhage due to pelvic injuries is rare. Severe head injuries predict a longer ICU stay in this population.
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