P. M. Elias1, M. B. Mulder1, W. J. Yang1, S. Rodriguez1, D. Wietecha1, A. Cohen1, E. A. Perez1, J. E. Sola1, N. Namias1, K. G. Proctor1, C. M. Thorson1 1University Of Miami,Dewitt Daughtry Department of Surgery: Division Of Pediatric Surgery,Miami, FL, USA
Introduction:
Pediatric pelvic fractures are generally rare and most previous studies have been limited by sample size. As a result, risk factors for mortality are poorly defined. To address this issue, we present one of the largest reviews of pediatric pelvic fractures in the past decade.
Methods:
All patients age 0-17 admitted with pelvic fractures at a single level I trauma center from January 1, 1998 to December 31, 2017 were retrospectively reviewed. Univariate and multivariate analysis identified predictors of mortality.
Results:
There were 8,758 admissions and 163 pelvic fractures, for an overall incidence of 1.86%. Age was 12.9 ± 4.8y with 61% male (n=99), 44.2% African American (n=72), and 27.6% White Hispanic (n=45). Males more commonly sustained gunshot wounds (15.2% vs. 0%) and associated gastrointestinal injuries (17.2% vs. 4.7%) vs. females, both p < 0.01. Mortality was 11.8% (n=19) and was higher in males vs. females (16.5% vs. 4.7%, p=0.023); in fact, 84% of all deaths were in male patients. Those that died were more likely to have additional organs injured including the brain (28.9% vs. 6.5%), liver (22.6% vs. 9.2%) spleen (26.7% vs. 8.4%), major vascular (33.3% vs. 9.1%), chest (21.1% vs. 3.5%), heart (66.7% vs. 8.6%), and spine (23.8% vs. 7.6%), all p < 0.05. The majority of deaths were in males (84%) and those with brain injuries (58%), whereas there were no deaths in patients with isolated pelvic fractures (n=19). Other factors associated with mortality were requiring an operation for chest injuries (50% vs. 9.8%) or arriving in shock (44.5% vs. 7.7%), both p <0.05. On multivariate regression, male gender (OR 6.03 [1.23-29.6], p=0.027), brain injury (OR 6.18 [1.81-21.1], p=0.004), spine injury (OR 5.06 [1.41-18.1], p=0.01), and cardiac injury (OR 35.0 [4.29-286], p=0.001) were independently associated with mortality.
Conclusion:
Pelvic fractures are rare in pediatric patients, even at a high-volume center. Male gender and additional injuries, especially brain, spine, and/or cardiac, are associated with an increased risk of death in these patients. On the other hand, isolated pelvic fractures have an extremely low mortality.