Lynch J M, Gardner M J, Albanese C T
Department of Surgery, University of Pittsburgh School of Medicine, PA, USA.
Pediatr Emerg Care. 1995 Dec;11(6):372-5. doi: 10.1097/00006565-199512000-00010.
Blunt traumatic injury to the urogenital region in the prepubescent girl is commonly evaluated in pediatric emergency departments (ED). The purpose of this study is: 1) to establish recommendations for an accurate, painless (both physically and psychologically), and timely diagnosis, and 2) to determine whether the ED examination can accurately determine the extent of the injury. Over a 24-month period (January 1991 through December 1992), 22 girls with blunt trauma to the urogenital region (mean age 5.7 years, range 2-9 years) were retrospectively evaluated. Initial ED evaluations were by both an emergency physician and a pediatric surgeon. All 22 patients underwent an examination under anesthesia (EUA) in the operating room to evaluate the extent of the injury and to repair the injury as needed. Follow-up was obtained in all patients and averaged 18 months. The findings at EUA demonstrated a significant disagreement with the preoperative ED evaluation. In only five patients was there agreement between the preoperative ED assessment and the findings during the EUA (24% concurrence). Thus, 16 patients (76%) had injuries of greater extent than was appreciated during the preoperative examination in the ED. Partial or complete disruption of the perianal sphincters occurred in six patients (27%) and was unrecognized preoperatively in each. Twenty-one of the 22 patients required suture repair of lacerations, the remaining patient did not require surgical therapy. Three patients had contusions or lacerations to the urethral area requiring repair and/or prolonged bladder catheter drainage for two to 14 days (average seven days). The average hospital stay was 19.3 hours. There were three minor wound complications following surgery: two required repeat EUA with suturing or cauterization, and one required no further therapy. This study clearly demonstrates that the ED examination, by both emergency physicians and pediatric surgeons, of young girls who have suffered blunt urogenital trauma grossly underestimates the severity of injuries when compared to the EUA in the operating room. EUA is safe and allows early discharge with minimal psychologic sequelae. Recommendations for mandatory EUA are made.
青春期前女孩泌尿生殖区域的钝性创伤常在儿科急诊科进行评估。本研究的目的是：1）制定准确、无痛（包括身体和心理方面）且及时的诊断建议；2）确定急诊科检查能否准确判定损伤程度。在1991年1月至1992年12月的24个月期间，对22名泌尿生殖区域遭受钝性创伤的女孩（平均年龄5.7岁，范围2 - 9岁）进行了回顾性评估。最初由一名急诊医生和一名小儿外科医生在急诊科进行评估。所有22例患者均在手术室接受了麻醉下检查（EUA），以评估损伤程度并根据需要修复损伤。对所有患者进行了随访，平均随访时间为18个月。EUA的检查结果显示与术前急诊科评估存在显著差异。术前急诊科评估与EUA期间的检查结果仅在5例患者中一致（一致性为24%）。因此，16例患者（76%）的损伤程度比术前急诊科检查所判断的更为严重。6例患者（27%）发生了部分或完全性肛门括约肌断裂，且术前均未被识别。22例患者中有21例需要缝合修复撕裂伤，其余1例患者不需要手术治疗。3例患者尿道区域有挫伤或撕裂伤，需要修复和/或留置膀胱导管引流2至14天（平均7天）。平均住院时间为19.3小时。术后有3例轻微伤口并发症：2例需要再次进行EUA并缝合或烧灼处理，1例无需进一步治疗。本研究清楚地表明，与手术室的EUA相比，急诊医生和小儿外科医生对遭受泌尿生殖区域钝性创伤的年轻女孩进行的急诊科检查严重低估了损伤的严重程度。EUA是安全的，且能使患者尽早出院，心理后遗症最小。提出了强制性进行EUA的建议。
