A comparison study of pelvic fractures and associated abdominal injuries between pediatric and adult blunt trauma patients.
OBJECTIVE
Pelvic fractures are a marker of severe injury, mandating a thorough investigation for the presence of associated injuries. Anatomical and physiological differences between adults and children may lead to a different impact of pelvic fractures on these populations. The purpose of this study is to compare pelvic fractures between pediatric and adult blunt trauma victims, mainly regarding their severity and associated intraabdominal injuries.


METHODS
A retrospective study involving blunt trauma patients suffering pelvic fractures, according to the records of the Israeli National Trauma Registry. Patients included children, aged 0-14years, and adults between 15 and 64years. The presence and severity of associated injuries were assessed.


RESULTS
Overall, 7621 patients aged 0-64years were identified with pelvic fractures following blunt trauma. The incidence of pelvic fractures in children was (0.8%), as compared to 4.3% in adults, p <0.0001. The most common mechanism of injury was motor vehicle accident (MVA) in adults, and pedestrian hit by car (PHBC) in children. About a quarter of the patients in both groups had an ISS >25. Adults sustained significantly more moderate to severe pelvic fractures (AIS≥3) than children (26.7% vs. 17.4%, p<0.0001). The overall mortality rate was similar among the two groups (5.4% in adults, 5.2% in children, p=0.7554). The only associated injury with statistically significant difference in incidence among the two groups was rectal injury (1.2% among children, 0.2% among adults, p<0.0001). Among adult patients, there was a clear correlation between the severity of pelvic fractures and the severity of concomitant splenic and hepatic injuries (p=0.026, p=0.0004, respectively). Among children, a similar correlation was not demonstrated.


CONCLUSIONS
Adults involved in blunt trauma are more likely to sustain pelvic fractures, and these are generally more severe fractures, as compared to children suffering from blunt trauma. Nonetheless, mortality rates were found similar in both groups. The only associated injury with statistically significant difference in incidence among the two groups was rectal injury. In adults, but not in children, higher grade pelvic fractures correlated with more severe concomitant splenic or hepatic injuries.


METHODS
The level of evidence for this study is III (3).
General Surgery Department, Bnai-Zion Medical Center, Haifa, Israel. Electronic address: foratola@gmail.com.
Forat
F
Swaid
National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; Disaster Medicine Department, School of Public Health, Tel-Aviv University, Israel.
Kobi
K
Peleg
Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel.
Ricardo
R
Alfici
Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel.
Oded
O
Olsha
National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel.
Adi
A
Givon
Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel.
Boris
B
Kessel
D000007:Abdominal Injuries / Q000150:complications*; D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D007557:Israel; D008099:Liver / Q000293:injuries; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D010384:Pelvic Bones / Q000293:injuries*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000293:injuries; D013898:Thoracic Injuries / Q000150:complications; D014949:Wounds, Nonpenetrating; D055815:Young Adult
Associated injuries; Blunt trauma; Pelvic fractures