The clinical presentation of pediatric pelvic fractures

Background: Few studies have addressed the presentation and clinical impact of pediatric pelvic fractures. We sought to describe pediatric blunt traum a patients with pelvic fracture (PF) and to evaluate the sensitivity and sp ecificity of physical examination at presentation for diagnosis. Methods: Retrospective analysis of all PF and control (NPF) patients from o ur pediatric institution over an 8-year period. Results: A total of 174 patients (88 PF, 86 NPF) were included. Median pati ent age was 8 years (range, 3 months to 18 years), with 54% males. The most common mechanisms of injury for PF patients were automobile-related accide nts (75%), There were 140 patients (87%) who were transported by air or gro und medical services. At presentation, approximately 16% of PF patients had a Glasgow Coma score of <15, a mean Revised Trauma Score of 7.49, and a me dian Injury Severity Score (ISS) of 9, Thirty-one PF patients (35%) had an ISS of >15 indicating severe, multiple injuries. Sixty-eight PF patients (7 7%) had severe isolated injuries (Abbreviated Injury Scale 1990 value of >3 ); 11% of PF patients required transfusions, and 2% died. Fifteen PP patien ts (17%)had no pelvic ring disruption; 39 (43%) had a single pelvic ring fr acture, 22 (2%) had two pelvic ring fractures, 2 (2%) had acetabular fractu res, and 10 (11%) had a combination of pelvic fractures. An abnormal physic al examination of the pelvis was noted in 81 patients with PF (92% sensitiv ity, 95% confidence interval [CI] = 0.89-0.95), 15 NPF patients had an abno rmal examination (79% specificity, 95% CI = 0.74-0.84). The positive predic tive value of the pelvis examination was 0.84, and the negative predictive value was 0.89. The most common abnormal pelvis examination finding was pel vic tenderness in 65 PF patients (73%), A total of seven PF patients had a normal examination of the pelvis; four had a depressed level of consciousne ss (defined as GCS <15), and six patients had a distracting injury. Conclusions: Pediatric blunt trauma patients with pelvic fracture represent a severely injured population but generally have lower transfusion rates a nd mortality than noted in adult studies, The pelvis examination appears to be sensitive and specific in this retrospective study. However, an altered level of consciousness and/or distracting injuries may affect examination sensitivity and specificity. Based on this retrospective study, we cannot a dvocate eliminating pelvic radiographs in the severely injured, blunt traum a patient. Prospective studies are recommended.