Mechanisms of blunt perineal injury in female pediatric patients

Abstract

Background/purpose: Controversy persists regarding the causes of and the morbidity associated with blunt perineal injuries in children. The purpose of this study was to determine the most common mechanisms of blunt perineal trauma in female pediatric patients and to define the subset of patients that may benefit the most from an examination under anesthesia (EUA).

Methods: Nearly 4,450 female pediatric patients were entered in the Pennsylvania Trauma Outcome Study database between 1993 and 1997. The mechanism and extent of perineal injury, surgical repair, and associated injuries were examined for all girls 0 to 16 years of age with a diagnosis of blunt perineal trauma.

Results: A total of 358 girls experienced blunt perineal trauma. Motor vehicle crashes (MVC) accounted for the majority of injuries in all age groups. Falls and bicycle-related injuries were significantly more prevalent in children less than 9 years of age, and assaults in children 0 to 4 years. Head trauma was the most common associated injury in children less than 15 years. Children less than 10 years of age required surgical repair of their perineal injuries more frequently than their older counterparts. Perineal injuries caused by falls, assaults, or playground-related equipment were more likely to require surgical repair than those caused by other mechanisms.

Conclusions: Perineal injuries that require surgical repair occur predominantly in patients less than 10 years of age who sustain blunt perineal trauma from a variety of causes, but rarely MVC. Thus, such patients should undergo aggressive evaluation, including EUA, especially if they present with perineal bleeding, hematoma, or swelling. Furthermore, perineal injuries in children under 4 years should raise the suspicion of abuse.