Pelvic fractures in pediatric and adult trauma patients: are they different injuries?
BACKGROUND
Many aspects of pediatric trauma are considerably different from adult trauma. Very few studies have performed comprehensive comparisons between pediatric and adult pelvic fractures. The purpose of this study was to compare the incidence of pelvic fracture, the epidemiologic characteristics, type of associated abdominal injuries, and outcomes between pediatric (age </= 16 years) and adult (age > 16 years) patients.


METHODS
This was a trauma registry study that included all blunt trauma admissions at a Level I trauma center during an 8-year period. The incidence and severity of pelvic fractures, associated abdominal injuries, need for blood transfusion, and mortality in the two age groups were compared with the two-sided Fisher's exact test. Stepwise logistic regression analysis was used to identify independent risk factors for associated abdominal injuries in pelvic fractures in the two age groups.


RESULTS
The incidence of pelvic fractures was 10.0% (1,450 of 14,568) in the adult group and 4.6% (95 of 2,062) in the pediatric group (p < 0.0001). In motor vehicle and pedestrian injuries, adults were twice as likely and in falls from heights > 15 ft seven times as likely as children to suffer pelvic fractures. However, age group was not a significant predictor of the severity of pelvic fracture. Only 9.5% of pediatric fractures and 8.8% of adult fractures had a pelvis Abbreviated Injury Scale (AIS) score >/= 4. The incidence of associated abdominal injuries was high but similar in the two age groups (16.7% in adults and 13.7% in children, p = 0.48). Motor vehicle crash, pelvis AIS score >/= 4, and fall from height > 15 ft were significant predictors of associated abdominal injuries in the adult but not the pediatric group. The incidence of associated gastrointestinal injuries was similar in the two age groups (5.3% in children and 3.3% in adults, p = 0.37). The incidence of solid organ injuries was nearly identical in both groups (11.6% in children and 11.5% in adults). The need for blood transfusions and angiographic intervention was not significantly different between the two age groups. Exsanguination because of bleeding related to the pelvic fracture was responsible or possibly responsible in 42 deaths (2.9%) in the adult group and no deaths in the pediatric group.


CONCLUSIONS
Pediatric trauma patients are significantly less likely than adults to suffer pelvic fractures, although the age group is not a significant risk factor for the severity of pelvic fracture. The incidence of associated abdominal injuries is high and similar in the two age groups. Motor vehicle crash, fall from a height, and pelvis AIS score >/= 4 were significant predictors of associated abdominal injuries in the adult but not the pediatric patients. The need for blood transfusion is similar in both groups irrespective of Injury Severity Score and pelvis AIS score. The mortality resulting from exsanguination related to pelvic fractures is very low, especially in pediatric patients.
Demetriades
Demetrios
D
Department of Surgery, University of Southern California, Los Angeles, USA. demetria@hsc.usc.edu
Karaiskakis
Marios
M
Velmahos
George C
GC
Alo
Kathleen
K
Murray
James
J
Chan
Linda
L
D000007:Abdominal Injuries / Q000453:epidemiology; D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000453:epidemiology*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D010384:Pelvic Bones / Q000293:injuries*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000145:classification / Q000453:epidemiology*