D. B. Horkan2, M. L. Bandeian1, J. E. Sola1, C. A. Karcutskie2, C. J. Allen2, E. A. Perez1, E. B. Lineen1, A. R. Hogan1, H. L. Neville1 1University Of Miami,Division Of Pediatric Surgery,Miami, FLORIDA, USA 2Ryder Trauma Center, Holtz Children’s Hospital,Division Of Pediatric Surgery,Miami, FLORIDA, USA
Introduction: The literature related to pediatric injury during recreational water sports is sparse. Herein, we compare pediatric water sports-related injury (WSI) factors to those occurring in the better documented mechanism of motor vehicle collision-related injuries (MVC).
Methods: Retrospective review of 1935 patients aged <18 years admitted to a level 1 pediatric trauma center from 1/2000-8/2013 was performed. Demographics, injury descriptors, and outcomes were reviewed for each patient. Categorical variables were compared by Chi square or Fisher’s exact test, and continuous by t-test or Mann Whitney U test. Parametric data are reported as mean ± standard deviation and nonparametric as median (interquartile range). Significance was set at alpha level 0.05.
Results: Eighteen patients were admitted for WSI excluding drownings. Age was 12±4 years, 72% male, 89% white, 44% tourists, 67% blunt injury, Injury Severity Score (ISS) 11±10, and Revised Trauma Score (RTS) 7.841(6.055-7.841). Penetrating/propeller injury accounted for all non-blunt injuries. 44% occurred by personal water craft, 39% by boat, and 17% by other means (diving/tubing/kite surfing). The most common WSI included skin/soft-tissue lacerations (59%), head injury/concussion (33%), tendon/ligament lacerations (28%), and extremity fractures (28%). Compared to 615 patients admitted for MVC, age, sex, race, Glasgow Coma Scale, ISS, RTS, spleen and liver laceration rates, neurosurgical consultation, ICU admission, ICU and total lengths of stay (LOS), and mortality were similar. WSI compared to MVC occurred more often in non-Hispanics (83% vs. 65%, p=0.43) and tourists (44% vs. 5%, p<0.000), were more often transferred from an outside hospital (39% vs. 8%, p=0.003), and more often occurred by penetrating mechanism (33% vs. 0.2%, p<0.000). WSI showed a significantly higher requirement for any surgical intervention (61% vs. 15%, p=0.001). The rate of open fracture (28% vs. 6%, p=0.006) and, subsequently, orthopedic procedures (39% vs. 17%, p=0.027) were also higher.
Conclusion: WSI more often occur by a penetrating mechanism and show higher operative rates than MVC injuries of similar severity occurring in a pediatric population. Higher rate of transfer for WSI reflects this greater requirement for surgical care. Primary prevention strategies, particularly targeting tourists and tourist venues, should be implemented to reduce water sport-related injuries.
