Retrospective review of unintentional female genital trauma at a pediatric referral center.
Unintentional female genital trauma is a complaint commonly seen and managed through the emergency department. The purpose of this study was to review all unintentional female genital trauma evaluated at The Hospital for Sick Children for 3.5 years to determine the factors associated with gynecologic consultation and need for operative repair.


METHODS
One hundred five patients were identified by health record coding. Data were extracted to study factors associated with gynecologic consultation and operative repair. Statistical analyses were performed to evaluate the significance of these associations. Surgical choices were also evaluated.


RESULTS
Mean age was 5.60 years. Mean time to presentation was 7.05 hours. Straddle injury was the most common mechanism (81.90%), and only 4.76% injuries were penetrating. Of the 105 patients, 48.57% consulted the gynecology section, 19.05% were taken to the operating room, and 6.66% were treated under conscious sedation. Overall, 20.95% required surgical repair. The most common complication was dysuria. Six patients had other injuries, the most common of which were pelvic fractures related to trauma.Factors significantly associated with gynecologic consultation and operative management included older age, transfer to our institution, shorter time to presentation, laceration-type injury, hymenal injury, and larger size of injury. Straddle injuries were significantly less likely to be taken to the operating room. When cases were stratified by a surgeon, there were no significant differences in management.


CONCLUSIONS
Unintentional female pediatric genital traumas most commonly result from straddle injuries. Most injuries are minor, and in this cohort, only 48.57% received gynecologic consultation and 19.05% required operative management. Future prospective studies would be useful to better evaluate the efficacy of surgical choices.
Spitzer
Rachel F
RF
Department of Pediatrics, Division of Endocrinology, Section of Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Kives
Sari
S
Caccia
Nicolette
N
Ornstein
Melanie
M
Goia
Cristina
C
Allen
Lisa M
LM
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation / Q000706:statistics & numerical data; D003288:Contusions / Q000453:epidemiology / Q000209:etiology; D003430:Cross-Sectional Studies; D053159:Dysuria / Q000209:etiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology; D005836:Genitalia, Female / Q000293:injuries* / Q000601:surgery; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D006924:Hymen / Q000293:injuries; D007223:Infant; D022125:Lacerations / Q000453:epidemiology / Q000209:etiology; D010384:Pelvic Bones / Q000293:injuries; D012017:Referral and Consultation; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000453:epidemiology / Q000628:therapy