Short-term pelvic fracture outcomes in adolescents differ from children and adults in the National Trauma Data Bank

Abstract

BackgroundPediatric pelvic fractures are associated with high-energy trauma and injury to other systems, leading to an increased incidence of complication and mortality. Previous studies analyzed the pediatric population as a whole, including both children and adolescents. The purpose of this study was to examine whether adolescents with pelvic fracture have different complication and mortality rates compared to younger children and adults.MethodsUsing the National Trauma Data Bank, 37,784 patients below the age of 55 years with pelvic fractures were identified and divided into children (age <13 years), adolescents (age 13–17 years), and adults (age >17 years). Descriptive statistics and bivariate and multivariate analyses were performed.ResultsChildren had an increased odds of death [odds ratio (OR) 2.29, 95 % confidence interval (CI) 1.96–2.67] and complications (OR 1.36, 95 % CI 1.20–1.55), whereas adolescents had a decrease in odds of death (OR 0.89, 95 % CI 0.74–1.06) and complications (OR 0.70, 95 % CI 0.61–0.81) compared to the adult population.ConclusionsAdolescents with pelvic fractures exhibit a different physiologic response to the children and adult populations. This emphasizes the need to distinguish these subpopulations in future epidemiological research and treatment planning.

Paediatric pelvic fractures: How do they differ from adults?

“…Mortality in our paediatric group was 6% which was comparable with other authors. However, the study by Marmor et al 4 reviewed the United States national databank and mortality was 10.2%. This might advocate treatment in specialised trauma centres with specific knowledge of treatment of the rare injuries.…”

“…Pelvic fractures in children are rare, with an incidence estimated to be in the range of 0.5% to 7.0% [1][2][3][4] of all blunt paediatric traumas. However, mortality is significant with a reported range of 1.4% to 25% and an average of 6.4%.…”

Paediatric pelvic fractures – an updated literature review

“…Pelvis fractures are rare; while 180 in 1000 children in the USA will fracture a bone in their childhood (between 0 and 19 years old), only 1 in 1000 children will sustain a pelvic fracture in the same time period 4 . Estimates vary between cohort studies, with some demonstrating that the incidence of pelvic fractures is between 0.04–4.6% of paediatric trauma patients 5–9 . Recently, Salášek et al .…”

“…Furthermore, the mortality rates differ between adolescents and younger children. In a study of 24 684 patients with pelvic fractures (including those with other associated injuries), children (aged less than 13 years old) with any closed pelvic fracture had increased odds of death (OR 2.29, 95% CI 1.96–2.67) compared with adults, while adolescents (aged 13–17 years old) did not (OR 0.89, 95% CI 0.74–1.06) ( P < 0.05) 6 . Other factors associated with mortality include a pelvic ring soft tissue injury ( P = 0.004), positive FAST examination ( P = 0.004) and admission to an intensive care unit ( P < 0.001) 144 …”

Computer and magnetic resonance imaging for pelvic fractures in children

“…Детский таз обладает большей эластичностью в крестцово-подвздошных суставах и симфизе, что делает переломы зависимыми от сил с высокой энергией [1,9]. Анализ частоты травм таза показал, что чаще всего это следствие дорожнотранспортных происшествий (ДТП), далее сле-дуют кататравма и невыясненные обстоятельства, редко спортивная травма [9][10][11][12][13]. Переломы костей и другие повреждения таза до 87% сочетаются с черепно-мозговой, торакоабдоминальной травмой и переломами других костей скелета [9,14].…”