Pelvic fracture geometry predicts risk of life-threatening hemorrhage in children
Related Experiment Videos
R C McIntyre1, D D Bensard, E E Moore
1Department of Surgery, University of Colorado Health Sciences Center, Denver 80262.
Insights
Pediatric pelvic fractures can cause severe bleeding. Fracture geometry helps identify children at risk for hemorrhage, necessitating prompt multispecialty care for these trauma patients.
Area of Science:
- Pediatric Traumatology
- Orthopedic Surgery
- Emergency Medicine
Background:
- Previous research suggested pediatric pelvic fractures do not cause life-threatening hemorrhage.
- This study challenges that notion, hypothesizing significant bleeding risk in pediatric pelvic fractures.
Purpose of the Study:
- To investigate the occurrence of major bleeding in pediatric pelvic fractures.
- To determine if fracture geometry can predict severe hemorrhage risk in children.
- To identify risk factors for hemorrhage in pediatric pelvic fractures.
Main Methods:
- Retrospective analysis of 1044 pediatric trauma patients, identifying 57 with pelvic fractures.
- Classification of pelvic fractures by geometry (Types I-IV).
- Evaluation of hemorrhage risk factors including fracture type, mechanism of injury, and patient demographics using logistic regression.
Main Results:
- 32.6% of pediatric pelvic fracture patients required blood transfusions.
- Pelvic fracture geometry, specifically types III and IV, was independently associated with increased risk of major bleeding.
- Angiography and embolization were effective in controlling arterial hemorrhage.
Conclusions:
- Pelvic fracture geometry is a critical factor in identifying pediatric trauma patients at high risk for severe hemorrhage.
- Early recognition and a multispecialty approach are crucial for managing pediatric pelvic fractures with significant bleeding potential.
Abstract:
Recent studies have concluded that pelvic fractures in children, unlike those in adults, are not a source of life-threatening hemorrhage. Our study hypothesis was that major bleeding occurs in children with pelvic fractures, and fracture geometry allows early identification of patients at risk for severe hemorrhage. Fifty-seven (5.5%) of 1044 pediatric trauma patients sustained pelvic fractures. The majority of injuries were from motor vehicle crashes (n = 21, 36.8%) and auto-pedestrian collisions (n = 18, 31.6%). Twenty-three children (40.4%) had unilateral anterior fractures (type I), seven (12.2%) had unilateral posterior fractures (type II), 23 (40.4%) had unilateral anterior and posterior fractures (type III), and four (7%) had bilateral anterior and posterior (type IV) fractures. Eighteen children (32.6%) required blood transfusions during the initial 48 hours (mean, 59 mL/kg). Skeletal fixation was applied in ten patients (17.5%), and it controlled bleeding in six (60%). Pelvic angiography identified arterial hemorrhage in three of four patients, and embolization controlled bleeding in all cases. The only death in the series (mortality, 1.7%) was from multisystem trauma. Age, sex, Injury Severity Score, Revised Trauma Score, mechanism of injury, and pelvic fracture geometry were evaluated as risk factors predictive of hemorrhage employing multiple logistic regression. Only pelvic fracture geometry independently identified patients at increased risk of major bleeding. We conclude that pelvic fracture geometry identifies a subset of pediatric trauma patients at high risk for life-threatening hemorrhage and urge a prompt multispecialty approach to these patients.