Genitourinary Injuries in Pediatric All-terrain Vehicle Trauma—A Mechanistic Relationship?

Mechanistic Relationship of All-terrain Vehicles and Pediatric Renal Trauma

All-terrain vehicle and bicycle crashes in children: Epidemiology and comparison of injury severity

FR01-05 THE HISTORY OF GENITOURINARY BLAST TRAUMA

Outcomes in Geriatric Genitourinary Trauma

Severely injured patients with associated genitourinary (GU) injuries have only rarely been investigated in the current literature. If at all, analyses are commonly focussed on renal injuries, marginalising other GU traumas such as ureteral injuries. In this study, we would like to characterise patients with GU injuries and analyse the impact of such injuries on mortality and length of stay. The inclusion criteria for this retrospective analysis of TraumaRegister DGU® data were: Injury Severity Score ≥ 16 within the period between 2009 and 2016 with available data on age and length of stay. Adescriptive analysis was used to compare patients with and without GU injuries. The impact of GU injuries on mortality and length of hospital stay was evaluated by means of multivariate regression analyses. In all, 90,962patients met the inclusion criteria; 5.9% of them had suffered GU injuries (n = 5345). The prevalence in patients with pelvic fractures was up to 19%. On average, patients with GU trauma were 10years younger (42.9 vs. 52.2years) and more severely injured (ISS: 31.8 vs. 26.4). The multivariate analyses demonstrated that GU injuries in severely injured patients are no independent risk factor for mortality. However, particularly bladder and genital injuries result in longer hospitalisation. GU injuries do not represent an additional risk factor for mortality. However, after adjusting for established prognosis factors, they can cause prolonged periods of hospitalisation of severely injured patients.

Until recently, female U.S. service members (SMs) have not been permitted to serve in direct combat roles. However, during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), a large number of female SMs have been wounded while serving in combat support roles. This included an unprecedented number of women with genitourinary (GU) injuries. No previous studies have reported either the incidence or clinical picture of these injuries. The objective of this study is to describe the epidemiology of GU injuries among female U.S. SMs during OIF/OEF and understand the potential for increased female GU injuries in future conflicts and the long-term sequelae from these injury patterns. The Department of Defense Trauma Registry was reviewed to identify all U.S. SMs diagnosed with GU injury from 2001 to 2013. The Department of Defense Trauma Registry includes data for wounded SMs treated at any U.S. combat support hospital, the in-theater equivalent of a civilian trauma center. Female SMs with ICD-9-CM diagnosis codes and/or Abbreviated Injury Scale codes for GU injury were included. Data on all females with GU injury were reviewed, including battle injury (BI) and non-BI. Basic demographic and injury characteristics were reported. Among the 1,463 U.S. SMs diagnosed with GU injury while deployed to OIF/OEF, 20 (1.4%) were female (median age: 25 yr; interquartile range 21-27 yr). Of these, nine were BI (45%) and 11 were non-BI (55%). The distribution of injury location was as follows: renal injuries (n = 12), vulvar injuries (n = 3), vaginal injuries (n = 3), perineal injury (n = 1), and bladder injury (n = 1). Median Injury Severity Score was in the severe range of 21 (interquartile range 6-32), and four women (20%) died of their wounds. Important associated injuries included colorectal (n = 5) and lower extremity amputation(s) (n = 2). The most common mechanism of injury among the nine women with GU BI was improvised explosive device blast (n = 6), followed by other explosions (n = 2) and gunshot wound (n = 1). Mechanisms of GU non-BI varied, including gunshot wound (n = 2), fall (n = 2), fire/flame (n = 1), knife wound (n = 1), unintentional machine injury (n = 1), motor vehicle accident (n = 1), sports injury (n = 1), fight (n = 1), and pedestrian injury (n = 1). Female GU injuries comprise a small portion of all GU injuries sustained during OIF/OEF with the most predominant being renal injury. Now that the ground combat exclusion policy has been lifted, these data can be used as a model for the expected injury patterns in future female combatants. Long-term applications for these data include research and development for personal protective equipment and development of a multidisciplinary approach to long-term comprehensive care following GU trauma.

Dirt Bikes and All Terrain Vehicles: The Real Threat to Pediatric Kidneys

Genitourinary (GU) trauma resulting from combat and the treatment of these injuries is an inadequately explored subject. While historically accounting for 2 to 5% of combat-related injuries, GU-related injuries escalated considerably during U.S. involvements in Iraq and Afghanistan due to improvised explosive devices (IEDs). Advanced body armor increased survivability while altering injury patterns, with a shift toward bladder and external genitalia injuries. Forward-deployed surgeons and military medics manage treatment, with Role 2 facilities addressing damage control resuscitation and surgery, including GU-specific procedures. The review aims to provide an overview of GU trauma and enhance medical readiness for battlefield scenarios. This review examined urologic trauma management in combat, searching PubMed, Cochrane Central, Scopus, and Web of Science databases with search terms "wounds" OR "injuries" OR "hemorrhage" AND "trauma" AND "penile" OR "genital" AND "combat." Records were then screened for inclusion of combat-related urologic trauma in conflicts after 2001 and which were English-based publications. No limits based on year of publication, study design, or additional patient-specific demographics were implemented in this review. Ultimately, 33 articles that met the inclusion criteria were included. Included texts were narrowed to focus on the management of renal injuries, ureteral trauma, bladder injuries, penile amputations, urethral injuries, testicular trauma, Central nervous system (CNS) injuries, and female GU injuries. In modern conflicts, treatment of GU trauma at the point of injury should be secondary to Advanced Trauma Life Support (ATLS) care in addition to competing non-medical priorities. This review highlights the increasing severity of GU trauma due to explosive use, especially dismounted IEDs. Concealed morbidity and fertility issues underscore the importance of protection measures. Military medics play a crucial role in evaluating and managing GU injuries. Adherence to tactical guidelines and trained personnel is vital for effective management, and GU trauma's integration into broader polytrauma care is essential. Adequate preparation should address challenges for deploying health care providers, prioritizing lifesaving and quality-of-life care for casualties affected by GU injuries.

MP04-09 POPULATION-BASED ANALYSIS OF OCCUPATION RELATED GENITOURINARY INJURIES: MALE EXTERNAL GENITALIA STILL AT RISK

Objective: A variety of educational efforts, policies, and regulations have been adopted to reduce all-terrain vehicle (ATV) injury in children. Despite this, ATV use by children continues and serious injuries...

PurposeTo determine the mechanisms of injury associated with occupational injuries (OI) to genitourinary (GU) organs and compare GU OIs with GU non-OIs.MethodsA single institution, retrospective study was conducted at a level 1 trauma center between 2010 and 2016 of all patients with GU injuries. OI was defined as any traumatic event that occurred in the workplace requiring hospital admission. Types of occupations were recorded in addition to the location of injury, mechanisms of injury, concomitant injuries, operative interventions, total cost, and mortality. GU OI patients were then compared to GU non-OI patients.Results623 patients suffered a GU injury, of which 39 (6.3%) had a GU OI. Fall (43%) was the most common mechanism of injury; followed by motor vehicle collision/motorcycle crash (31%), crush injury (18%), and pedestrian struck (8%). The adrenal gland (38%) and kidney (38%) were the most commonly injured organs. There was no difference in mortality (13% GU OI vs. 15% GU non-OI, p = 0.70) or total direct cost ($21,192 ± 28,543 GU OI vs. $28,215 ± 32,332 GU non-OI, p = 0.45). Total costs were decreased with mortality from a GU injury (odds ratio (OR) 0.3, CI 0.26–0.59; p = < 0.001) and increased with higher injury severity scores (OR 1.1, CI 1.09–1.2; p = < 0.0001). Total costs were not affected by OI status.ConclusionsOccupational GU trauma presents with similar patterns of injury, hospital course, and direct cost as GU trauma that occurs in non-occupational settings.

BackgroundUrological trauma significantly affects patient morbidity, functional outcomes, and healthcare resource utilization. This study evaluated war-related genitourinary (GU) injuries that occurred during the Israeli–Gaza War, with a focus on injury patterns, management, and clinical outcomes.MethodsWe conducted a retrospective analysis utilizing the Israeli National Trauma Registry, which is managed by the Gertner Institute for Health Policy and Epidemiology. This registry captures data on all of the patients admitted to trauma centers in Israel. Data quality is maintained through ongoing training of data abstractors and regular audits of registry data. All documented hospitalizations from October 7, 2023, to May 31, 2024, were included, excluding noncombat-related injuries. GU injuries were classified by anatomical location into the upper urinary tract (kidney/ureter), lower urinary tract (bladder/urethra), and external genitalia (penis/scrotum/testes). The data collected included demographics, injury mechanisms, injury severity score (ISS), surgical management, and clinical outcomes (ICU admissions, hospital length of stay [LOS], rehabilitation needs, and mortality). GU patients were compared with non-GU patients.ResultsOf the 2,422 total casualties, 117 (4.8%) sustained GU injuries. The mean age was 27.2 ± 9.2 years (range 14–76) in the GU-injured casualty group versus 30.1 ± 15.1 years (range 0–97) in the non-GU casualty group; the difference was not significant (p = 0.43), with 97.4% males. Explosive devices (59.0%) and gunshot wounds (36.8%) were the predominant injury mechanisms. Severe injuries (ISS ≥ 16) occurred significantly more frequently among GU-injured patients (61.5% vs. 21.6%, p < 0.0001). External genital injuries were the most common injuries (60.7%), followed by kidney (27.4%) and bladder damage (10.3%). Associated pelvic fractures occurred in 18% of the GU trauma patients versus 1.8% of the non-GU-injured patients (p < 0.0001). Surgical interventions were performed in 84.6% of the patients, among whom scrotal/testicular surgeries (27.4%) were most common. ICU admissions (44.4%), prolonged hospitalizations ≥ 14 days (41.4%), rehabilitation needs (53.0%), and mortality (6.8%) were significantly greater among GU-injured patients.ConclusionsWar-related GU trauma, although relatively uncommon, involves severe injuries, extensive surgical management, prolonged hospitalizations, and substantial rehabilitation demands. Enhancements in protective equipment and multidisciplinary treatment strategies are critical for optimizing outcomes in future conflicts.

Editorial comment.

Trends of Motor-Vehicle Related Genitourinary Trauma as Compared to Motor Vehicle Fatalities from 2012-2022.

PD31-06 MENTAL HEALTH ILLNESS AFTER EXTERNAL GENITOURINARY TRAUMA: A CASE-CONTROL STUDY IN A US POPULATION