title: Genitourinary injuries in pediatric all-terrain vehicle trauma--a mechanistic relationship?
abstract: OBJECTIVE
  To define and discuss the characteristics of all-terrain vehicle (ATV)-related pediatric (<16 years) genitourinary (GU) trauma. ATV collisions represent a significant and growing portion of trauma cases in rural America. ATV-related renal injuries have been reported in adults but a comprehensive review of ATV-related pediatric GU trauma cases is needed.
  
  
  METHODS
  A retrospective analysis of admissions to 2 trauma centers in Kentucky between 1997 and 2007 was performed, identifying youth who presented with ATV-related GU injuries. Demographics, injury data, and treatment records for children with GU trauma in this study population were recorded and analyzed.
  
  
  RESULTS
  A total of 429 youth were admitted after ATV injuries during the study period. Of these, 13 (7 boys, 6 girls) had GU injuries (3%) and the average age was 10.7 years. Of 13 patients, 12 (92%) were unhelmeted and the mean injury severity score was 10.3. Twelve of 13 (92%) suffered renal injuries (7 contusions, 5 lacerations) and 1 (8%) had an extraperitoneal bladder rupture. Renal lacerations were grade I-V. Hematuria was very common (10/12, 83%) and intensive care unit care was required in 5 of 12 (42%) patients. Mean length of stay was 5 days and 12 of 13 (92%) were discharged home. The most common associated injury was splenic laceration (4/13, 31%).
  
  
  CONCLUSIONS
  GU trauma in ATV-injured youth is uncommon but when it occurs, renal injuries predominate. Most present with hematuria. Prevalence of renal trauma among GU injuries in children suggests a unique injury mechanism (crush during ATV roll or strike of the handlebars) and more study of injury mechanics is warranted. A high index of suspicion is warranted in evaluating these children.
authors.affiliation: Department of Behavioral Science, University of Kentucky, Lexington, Kentucky 40503, USA. chasekluemper@uky.edu
authors.forename: Chase
authors.initials: C
authors.lastname: Kluemper
authors.forename: Aimee
authors.initials: A
authors.lastname: Rogers
authors.forename: Mary
authors.initials: M
authors.lastname: Fallat
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Bernard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007668:Kidney / Q000293:injuries*; D008297:Male; D015541:Off-Road Motor Vehicles; D012189:Retrospective Studies; D001743:Urinary Bladder / Q000293:injuries*