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Death from pelvic fracture: children are different
N Ismail1, J F Bellemare, D L Mollitt
1Department of Surgery, University of Florida Health Science Center, Jacksonvile, 32209 USA.
Insights
Children experience fewer deaths from pelvic fractures than adults, with significantly lower rates of fatal exsanguination. Pediatric pelvic fractures rarely cause fatal hemorrhage, unlike in adults.
Area of Science:
- Trauma Surgery
- Pediatric Orthopedics
- Emergency Medicine
Background:
- Pelvic fractures are severe injuries with high mortality, particularly in adults.
- Understanding outcome differences between pediatric and adult pelvic fractures is crucial for targeted treatment.
Purpose of the Study:
- To compare mortality rates and causes of death between children and adults with pelvic fractures.
- To investigate the incidence of fatal exsanguination following pelvic fractures in different age groups.
Main Methods:
- Retrospective analysis of 23,700 children from the National Pediatric Trauma Registry (NPTR) and 10,720 adults from a level I trauma center registry.
- Fracture classification using a modified Key and Conwell system, categorized by open/closed type.
- Outcome assessment included mortality rate and fatal exsanguination incidence.
Main Results:
- Pelvic fractures were less frequent in children (3% of NPTR cases) compared to adults.
- Overall mortality was 5% in children versus 17% in adults.
- Fatal exsanguination occurred in 2 children vs. 18 adults; pelvic ring disruption was more common and lethal in adults.
Conclusions:
- Children have a significantly lower mortality rate from pelvic fractures than adults.
- Hemorrhage from pelvic fractures is a less common cause of death in children, often stemming from visceral injuries rather than pelvic vasculature.
Abstract:
This study compares outcome from pelvic fractures in children with that of adults. Data for 23,700 children registered in the National Pediatric Trauma Registry (NPTR) were compared with those of 10,720 adults recorded over 5 years in the registry of our level I trauma center. Patients were categorized by open versus closed fracture and by fracture type as defined by a modification of the Key and Conwell system. Outcome was evaluated by mortality rate and incidence of fracture-induced fatal exsanguination. The 722 pelvic fractures recorded in the NPTR represent 3% of the population and is half the frequency represented by the 532 adults evaluated (P < .001). The overall mortality rate was 5% for children and 17% for adults. Two children died of fracture-related exsanguination; there were 18 such deaths among the adults. Pelvic ring disruption was encountered more commonly among adults, and was associated with a significantly higher mortality rate. Patients with initial hemodynamic instability were more likely to die, although children less so than adults. The authors conclude that children do not die of pelvic fracture-associated hemorrhage as often as adults. Massive blood loss in the child occurs most commonly from solid visceral injury rather than from pelvic vascular disruption.