PELVIC FRACTURE GEOMETRY PREDICTS RISK OF LIFE-THREATENING HEMORRHAGEIN CHILDREN

Recent studies have concluded that pelvic fractures in children, unlik e those in adults, are not a source of life-threatening hemorrhage. Ou r study hypothesis was that major bleeding occurs in children with pel vic fractures, and fracture geometry allows early identification of pa tients at risk for severe hemorrhage. Fifty-seven (5.5%) of 1044 pedia tric trauma patients sustained pelvic fractures. The majority of injur ies were from motor vehicle crashes (n = 21, 36.8%) and auto-pedestria n collisions (n = 18, 31.6%). Twenty-three children (40.4%) had unilat eral anterior fractures (type I), seven (12.2%) had unilateral posteri or fractures (type II), 23 (40.4%) had unilateral anterior and posteri or fractures (type III), and four (7%) had bilateral anterior and post erior (type IV) fractures. Eighteen children (32.6%) required blood tr ansfusions during the initial 48 hours (mean, 59 mL/kg). Skeletal fixa tion was applied in ten patients (17.5%), and it controlled bleeding i n six (60%). Pelvic angiography identified arterial hemorrhage in thre e of four patients, and embolization controlled bleeding in all cases. The only death in the series (mortality, 1.7%) was from multisystem t rauma. Age, sex, Injury Severity Score, Revised Trauma Score, mechanis m of injury, and pelvic fracture geometry were evaluated as risk facto rs predictive of hemorrhage employing multiple logistic regression. On ly pelvic fracture geometry independently identified patients at incre ased risk of major bleeding. We conclude that pelvic fracture geometry identifies a subset of pediatric trauma patients at high risk for lif e-threatening hemorrhage and urge a prompt multispecialty approach to these patients.