BLUNT UROGENITAL TRAUMA IN PREPUBESCENT FEMALE-PATIENTS - MORE THAN MEETS THE EYE

Blunt traumatic injury to the urogenital region in the prepubescent gi rl is commonly evaluated in pediatric emergency departments (ED), The purpose of this study is: 1) to establish recommendations for an accur ate, painless (both physically and psychologically), and timely diagno sis, and 2) to determine whether the ED examination can accurately det ermine the extent of the injury, Over a 24-month period (January 1991 through December 1992), 22 girls with blunt trauma to the urogenital r egion (mean age 5.7 years, range 2-9 years) were retrospectively evalu ated, Initial ED evaluations were by both an emergency physician and a pediatric surgeon, All 22 patients underwent an examination under ane sthesia (EUA) in the operating room to evaluate the extent of the inju ry and to repair the injury as needed, Follow-up was obtained in ail p atients and averaged 18 months, The findings at EUA demonstrated a sig nificant disagreement with the preoperative ED evaluation, In only fiv e patients was there agreement between the preoperative ED assessment and the findings during the EUA (24% concurrence), Thus, 16 patients ( 76%) had injuries of greater extent than was appreciated during the pr eoperative examination in the ED, Partial or complete disruption of th e perianal sphincters occurred in six patients (27%) and was unrecogni zed preoperatively in each, Twenty-one of the 22 patients required sut ure repair of lacerations, the remaining patient did not require surgi cal therapy, Three patients had contusions or lacerations to the ureth ral area requiring repair and/or prolonged bladder catheter drainage f or two to 14 days (average seven days), The average hospital stay was 19.3 hours, There were three minor wound complications following surge ry: two required repeat EUA with suturing or cauterization, and one re quired no further therapy, This study clearly demonstrates that the ED examination, by both emergency physicians and pediatric surgeons, of young girls who have suffered blunt urogenital trauma grossly underest imates the severity of injuries when compared to the EUA in the operat ing room, EUA is safe and allows early discharge with minimal psycholo gic sequelae. Recommendations for mandatory EUA are made.