Genitourinary Injuries in Pediatric All-terrain Vehicle Trauma—A Mechanistic Relationship?
Received 1 May 2009; accepted 7 August 2009. published online 16 November 2009.
Objectives
To define and discuss the characteristics of all-terrain vehicle (ATV)-related pediatric (<16 years) genitourinary (GU) trauma. ATV collisions represent a significant and growing portion of trauma cases in rural America. ATV-related renal injuries have been reported in adults but a comprehensive review of ATV-related pediatric GU trauma cases is needed.
Methods
A retrospective analysis of admissions to 2 trauma centers in Kentucky between 1997 and 2007 was performed, identifying youth who presented with ATV-related GU injuries. Demographics, injury data, and treatment records for children with GU trauma in this study population were recorded and analyzed.
Results
A total of 429 youth were admitted after ATV injuries during the study period. Of these, 13 (7 boys, 6 girls) had GU injuries (3%) and the average age was 10.7 years. Of 13 patients, 12 (92%) were unhelmeted and the mean injury severity score was 10.3. Twelve of 13 (92%) suffered renal injuries (7 contusions, 5 lacerations) and 1 (8%) had an extraperitoneal bladder rupture. Renal lacerations were grade I-V. Hematuria was very common (10/12, 83%) and intensive care unit care was required in 5 of 12 (42%) patients. Mean length of stay was 5 days and 12 of 13 (92%) were discharged home. The most common associated injury was splenic laceration (4/13, 31%).
Conclusions
GU trauma in ATV-injured youth is uncommon but when it occurs, renal injuries predominate. Most present with hematuria. Prevalence of renal trauma among GU injuries in children suggests a unique injury mechanism (crush during ATV roll or strike of the handlebars) and more study of injury mechanics is warranted. A high index of suspicion is warranted in evaluating these children.
aDepartment of Behavioral Science, University of Kentucky, Lexington, Kentucky
bDivision of Urology, Department of Surgery, West Virginia University Health Sciences Center, Morgantown, West Virginia
dDivision of Pediatric Surgery, Department of Surgery, University of Louisville, Louisville, Kentucky
eDepartment of Surgery, University of Kentucky Chandler Medical Center, Lexington, Kentucky
Reprint requests: Chase Kluemper, B.S., Department of Behavioral Science, Residential Research Facility, University of Kentucky, 1401 Nicholasville Rd, Lexington KY 40503
ABSTRACT