title: Repair of pediatric bladder rupture improves survival: results from the National Trauma Data Bank.
abstract: OBJECTIVE
  The urinary bladder is the second most commonly injured genitourinary organ. The objective of this study was to describe the management of pediatric traumatic bladder ruptures in the United States and their association with surgical repair and mortality.
  
  
  METHODS
  We searched the 2002-2008 National Trauma Data Bank for all pediatric (<18 years old) subjects with bladder rupture. Demographics, mechanism of injury, coexisting injury severity, and operative interventions for bladder and other abdominal trauma are described. Multivariate logistic regression analysis was used to examine the relationship between bladder rupture and both bladder surgery and in-hospital mortality.
  
  
  RESULTS
  We identified 816 children who sustained bladder trauma. Forty-four percent underwent bladder surgery, including 17% with an intraperitoneal injury. Eighteen percent had 2 intra-abdominal injuries, and 40% underwent surgery to other abdominal organs. In multivariate analysis, operative bladder repair reduced the likelihood of in-hospital mortality by 82%. A greater likelihood of dying was seen among the uninsured and those with more severe injuries and multiple abdominal injuries.
  
  
  CONCLUSIONS
  After bladder trauma, pediatric patients demonstrate significantly improved survival when the bladder is surgically repaired. With only 67% of intraperitoneal bladder injuries being repaired, there appears to be underuse of a life-saving procedure.
authors.affiliation: Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. cmd2176@columbia.edu
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Deibert
authors.forename: Kenneth I
authors.initials: KI
authors.lastname: Glassberg
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Spencer
mesh_terms: D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012421:Rupture / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*