title: Prehospital predictors of risk for pelvic fractures in pediatric trauma patients.
abstract: Pelvic fractures are uncommon in children, but can occur as a result of high-energy impact injuries to the lower torso in association with blunt trauma. Pelvic fractures can be associated with significant morbidity while the work-up and treatment for these injuries is costly. The aim was to identify risk factors that help determine which pediatric trauma patients are at highest risk of sustaining a pelvic fracture to aid in the development of criteria for the targeted use of pelvic radiographic imaging. A retrospective analysis was conducted using the only pediatric trauma registry in the state of Maryland, located at The Johns Hopkins Children's Center. All blunt trauma patients who were younger than 15 years of age from 1990 to 2005 were included in the analysis (n = 13,360) with a final diagnosis of pelvic fracture as the primary outcome of interest. Comparisons were made using Pearson's chi-square for categorical and the Mann-Whitney rank sum test for non-normally distributed variables. Pelvic fractures following blunt trauma in children are associated with age, race, place and mechanism of injury. Compared to children 4 years and younger, pelvic fractures were more likely to occur in children aged 5-9 years (OR = 3; P = 0.000), as well as 10-14 years (OR = 5; P = 0.000). Compared to blunt trauma injuries from falls, children who were struck by vehicles or who were occupants in motor vehicle crashes (MVC) were six times (P = 0.000) and twice (P = 0.02) as likely to sustain a pelvic fracture, respectively. Four factors were demonstrated by this study to be significantly associated with pediatric pelvic fractures: being Caucasian, age between 5 and 14 years, being struck as a pedestrian or a motor vehicle crash occupant. Identification of these factors may aid clinicians in selecting patients who are at highest risk for pelvic fracture and may benefit most from pelvic radiography.
authors.affiliation: Division of Pediatric Surgery, Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Harvey 319, Baltimore, MD 21287, USA.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Nabaweesi
authors.forename: Meghan A
authors.initials: MA
authors.lastname: Arnold
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Mark I
authors.initials: MI
authors.lastname: Rossberg
authors.forename: Susan
authors.initials: S
authors.lastname: Ziegfeld
authors.forename: David E
authors.initials: DE
authors.lastname: Sawaya
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Bathurst
authors.forename: Paul
authors.initials: P
authors.lastname: Colombani
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010384:Pelvic Bones / Q000293:injuries*; D012189:Retrospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000150:complications*