W. J. Yang1, M. B. Mulder1, D. Wietecha1, A. L. Cohen1, M. S. Sussman1, E. A. Perez1, J. E. Sola1, N. Namias1, K. G. Proctor1, C. M. Thorson1 1University Of Miami,Daughtry Department Of Surgery,Miami, FL, USA
Introduction:
Pediatric pelvic fractures are rare even at high volume centers. Associated injuries are ill defined, and management often differs from adults. The aim of this study was to compare pediatric (< 18y) and adult (≥ 18y) pelvic fractures to identify disparities in incidence, associated injuries, interventions and outcomes.
Methods:
All pediatric pelvic fractures at a level I trauma center from 1998-2017 were retrospectively reviewed and compared to adult pelvic fractures from 2013-2017. Descriptive statistics and multivariate regression were performed with significance defined at p≤ 0.05.
Results:
The incidence of pelvic fractures was 2% (n=168) in pediatrics and 8%(n=1211) in adults (p≤0.001). Children were more likely to be injured in auto accidents (41% v 29%, p=0.001), while adults more often sustained falls (17% v 5%, p≤0.001). Despite a similar Injury Severity Score (ISS) (22±16 v 23±17, p=0.39), associated injuries differed between groups, with higher rates of pediatric injuries involving the spleen (20% v 13%, p=0.01) and kidney (13% v 8%, p=0.04), and lower rates of spine injuries (28% v 39% p≤0.001) compared to adults. Adults were nearly twice as likely to require angiography (3% v 7%, p=0.03), transfusions (14% v 37%, p≤0.001), or operative interventions involving the abdomen or chest (20% v 29%, p=0.007). Embolization for pelvic bleeding was required in 40 (3%) adults but only 1 (0.6%) child, p=0.053. Many injury-related factors were all found to be independent predictors of emergent operative interventions on multivariate regression (Table 1; AUC=0.907). In terms of discharge disposition, pediatric patients were more often discharged directly home (73% v 57%, p=0.004). Mortality rates were similar in pediatric and adult patients (13% v 15%, p=0.331). An equal proportion of pediatric (3%) and adult (3%) patients died from pelvic exsanguination (p=0.823), accounting for 22% of total mortalities. Most mortalities (72%) occurred in the first 24hrs.
Conclusion:
Pediatric pelvic fractures are rare. Children present with more associated abdominal injuries, likely due to the high force required to fracture the growing pelvis. A high proportion of patients with pelvic fractures will require urgent non-orthopedic operative intervention. Despite children being less likely to require interventions, mortality remains high and similar to that of adults.
