9th March 2018, Volume 131 Number 1471

Mohit Bajaj, Giorgio Stefanutti, Haemish Crawford, Vipul Upadhyay

Trauma is a leading cause of mortality in the paediatric patient population.1 Pelvic fractures are uncommon in children, but can occur as a result of high-energy blunt trauma, such as…

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Summary

We examined recent smoking trends among doctors and nurses in New Zealand using recent census data. We found that smoking had declined steadily and by 2013 only 2% of male and female doctors and 9% of male and 8% of female nurses were regular cigarette smokers. Smoking was more common among Māori doctors (7%) and nurses (19%), and also among psychiatric nurses. The findings suggest that New Zealand doctors had achieved the Smokefree 2025 goal of minimal (<5%) smoking prevalence and all nurses except psychiatric nurses were on track to do so. Targeted workplace smoking cessation support could be used to reduce smoking among key occupational groups such as Māori nurses.

Abstract

Aim

Pelvic fractures constitute between 0.3% and 4% of all paediatric injuries, with a mortality rate up to 25%. This study aims to review the experience with pelvic fractures at Starship Children’s Hospital and demonstrate its role as a marker of severe trauma.

Method

A retrospective review of children with pelvic fractures managed at our institution in the 20-year period between July 1995 and May 2015 was performed. The search identified 179 consecutive children admitted with a pelvic fracture. Data fields collected included patient details, mechanisms of injury, investigations performed, length of hospital stay, management and complications. Data was also collected on Injury Severity Score (ISS), Glasgow coma scale (GCS), transfusion requirements and details of associated injuries (both orthopaedic and non-orthopaedic).

Results

Median age was eight years (IQR 5-12 years) with 65% boys. The median Injury Severity Score (ISS) was 9 (IQR 4-22). Pedestrian-motor vehicle injuries were most common at 46% of cases, followed by passengers injured in motor vehicle accidents accounting for 23% (n=41). Associated injuries were present in 68% (n=122) of patients, with other orthopaedic fractures (42%, n=75) and thoracic injuries (33%, n=59) most common. Management of pelvic fractures was primarily non-operative, with only 7% (n=13) requiring operative intervention. In comparison, operative procedures for associated injuries were much more common and were required in 38% (n=68) of cases.

Conclusion

Pelvic fractures represent an important marker for severe trauma. Patterns of paediatric pelvic fractures reported by other studies around the world are very similar. Understanding the patterns in which pelvic fractures and their associated injuries occur and the outcome of treatment is fundamental to the establishment of effective preventative, diagnostic and therapeutic interventions.

Author Information

Mohit Bajaj, Paediatric Surgical Registrar, Starship Children’s Hospital, Auckland;
Giorgio Stefanutti, Paediatric Surgical Registrar, Starship Children’s Hospital, Auckland;
Haemish Crawford, Paediatric Orthopaedic Surgeon, Starship Children’s Hospital, Auckland;
Vipul Upadhyay, Paediatric Surgeon, Starship Children’s Hospital, Auckland.

Acknowledgements

Rong Hu (Research Statistical Consultant – Auckland District Health Board) for assistance with statistical analysis. 

Correspondence

Dr Mohit Bajaj, Paediatric Surgery Department, Starship Children’s Hospital, 2 Park Road, Grafton, Auckland 1023.

Correspondence Email

mohitb@adhb.govt.nz

Competing Interests

Nil.

References

  1. Gansslen A, Heidari N, Weinberg AM. Fractures of the pelvis in children: a review of the literature. Eur J Orthop Surg Traumatol, 2013; 23(8):847–61.
  2. Mazurek AJ, Epidemiology of paediatric injury. J Accid Emerg Med, 1994; 11(1):9–16.
  3. Bond SJ, Gotschall CS, Eichelberger MR, Predictors of abdominal injury in children with pelvic fracture. J Trauma, 1991; 31(8):1169–73.
  4. Chia JP, et al. Pelvic fractures and associated injuries in children. J Trauma, 2004; 56(1):83–8.
  5. Musemeche CA, et al. Selective management of pediatric pelvic fractures: a conservative approach. J Pediatr Surg, 1987; 22(6):538–40.
  6. Baker SP, et al. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma, 1974; 14(3):187–96.
  7. Teasdale G, Jennett B, Assessment of coma and impaired consciousness. A practical scale. Lancet, 1974; 2(7872):81–4.
  8. Torode I, Zieg D. Pelvic fractures in children. J Pediatr Orthop, 1985; 5(1): 76–84.
  9. Herring JA. Tachdjian’s Pediatric Orthopaedics: From the Texas Scottish Rite Hospital for Children, 2014, Elsiever Saunders.
  10. Silber JS, et al. Analysis of the cause, classification, and associated injuries of 166 consecutive pediatric pelvic fractures. J Pediatr Orthop, 2001; 21(4):446–50.
  11. Shore BJ, et al. Pediatric pelvic fracture: a modification of a preexisting classification. J Pediatr Orthop, 2012; 32(2):162–8.
  12. Upperman JS, et al., Early functional outcome in children with pelvic fractures. J Pediatr Surg, 2000; 35(6):1002–5.
  13. Nabaweesi R, et al. Prehospital predictors of risk for pelvic fractures in pediatric trauma patients. Pediatr Surg Int, 2008; 24(9)1053–6.
  14. Grisoni N, et al. Pelvic fractures in a pediatric level I trauma center. J Orthop Trauma, 2002. 16(7):458–63.
  15. Lane-O’Kelly A, Fogarty E, Dowling F. The pelvic fracture in childhood: a report supporting nonoperative management. Injury, 1995; 26(5):327–9.
  16. Rieger H, Brug E. Fractures of the pelvis in children. Clin Orthop Relat Res, 1997; (336):226–39.
  17. Banerjee S, Barry MJ, Paterson JM, Paediatric pelvic fractures: 10 years experience in a trauma centre. Injury, 2009; 40(4):410–3.
  18. Waddell JP, Drucker WR, Occult injuries in pedestrian accidents. J Trauma, 1971; 11(10):844–52.
  19. Snyder CL, et al. Blunt trauma in adults and children: a comparative analysis. J Trauma, 1990; 30(10):1239–45.
  20. Ismail N, et al. Death from pelvic fracture: children are different. J Pediatr Surg, 1996; 31(1):82–5.
  21. Leonard M, et al. Paediatric pelvic ring fractures and associated injuries. Injury, 2011; 42(10):1027–30.
  22. Demetriades D, et al. Pelvic fractures in pediatric and adult trauma patients: are they different injuries? J Trauma, 2003; 54(6):1146–51; discussion 1151.
  23. Turgut A, et al. Demographic Characteristics of Paediatric Pelvic Fractures: 10-Years’ Experience of Single Paediatric Orthopaedics Clinic. Eurasian J Med, 2015; 47(2):130–4.
  24. Nierenberg G, et al. Pelvic fractures in children: a follow up in 20 children treated conservatively. Journal of Pediatric Orthopaedics, 1992; 1(2).
  25. Schwarz N, et al. Long-term results of unstable pelvic ring fractures in children. Injury, 1998; 29(6):431–3.

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