PREDICTORS OF ABDOMINAL INJURY IN CHILDREN WITH PELVIC FRACTURE

During a 48-month period, 2,248 children (aged < 15 years) were consecutively admitted to a regional pediatric trauma center with blunt trauma (ICD-9-CM code greater-than-or-equal-to 800). Fifty-four children (2.4%) had injury to the pelvic circle, as diagnosed by radiographic examination; 13 of these children had concomitant abdominal or genitourinary (GU) injury. Contingency table analysis and stepwise logistic regression were used to determine the best predictors of abdominal injury. The mean age of the children was 8.6 years. Eighty-nine percent of the injuries were motor-vehicle related (59% pedestrian; 30% crash occupant). Nine children (17%) required transfusions of packed red blood cells; 9 children (17%) required surgery. There were 6 deaths in this group, a mortality rate of 11.1%. The most common fracture sites in the pelvis were the pubic rami (59%), ilium or pelvic rim (17%), and the sacrum (6%). Ten children (19%) had multiple pelvic fractures. Location of fracture was strongly associated with the probability of abdominal injury: 80% of children with multiple pelvic fractures had concomitant abdominal or GU injury, compared with 33% with fracture of the ilium or pelvic rim, and 6% with isolated pubic fractures (p < 0.001). The variables that best predicted abdominal or GU injury using a backward-elimination, stepwise logistic model were the presence of multiple pelvic fractures (p < 0.002) and unweighted Revised Trauma Score (p < 0.05); age of child, systolic blood pressure, respiration rate, Glasgow Coma Scale score, and mechanism of injury were not predictive. According to this model, the probability of abdominal injury, given physiologic stability, was less than 1% for isolated pubic fractures, 15% for iliac or sacral fractures, and 60% for multiple fractures of the pelvic ring.