S. Dadjoo1, J. C. Hakim2, M. L. Peterson1, P. I. Abbas1, M. E. Lopez1, M. L. Brandt1, J. E. Dietrich2 1Texas Children’s Hospital,The Michael E. DeBakey Department Of Surgery, Baylor College Of Medicine,Houston, TX, USA 2Texas Children’s Hospital,Department Of Obstetrics And Gynecology, Baylor College Of Medicine,Houston, TX, USA
Introduction:
Straddle injuries in females consist of blunt and/or penetrating trauma to the urogenital area. Treatment of Grade 1 and 2 straddle injuries most often consists of sitz baths, estrogen cream or antibiotic ointment. Surgical repair may be indicated for significant bleeding or deep lacerations. The purpose of this study is to report treatment and outcome of girls <18 years of age with Grade 1 or 2 straddle injuries who were treated as outpatients (< 24 hr observation) in a large, tertiary pediatric hospital.
Methods:
An IRB approved retrospective review of all patients with Grade 1 and 2 straddle injury seen at Texas Children’s Hospital in 2014 was performed. Exclusion criteria included male gender, admission >24 hours or concern for sexual abuse. Data collected included age, time of year, mechanism of injury, management, and outcomes.
Results:
There were 69 girls who met inclusion criteria. The mean age was 6 years (range 2-17). Injuries were most common in May and June (n=18, 26%). The main cause of injury was a fall at home (n=31), fall at school playgrounds (n=24), or a bicycle or scooter injury (n=10). There were no penetrating injuries in this series. 18 pts were transferred from an outside facility. 68% (n=47) of pts were managed solely by an emergency department (ED) physician, and 32% (n=21) were managed by the gynecologic or, less commonly, the surgical service. A consult from the ED was most often requested when pain prevented adequate examination and/or significant bleeding or deep lacerations were present. 15 patients (22%) required surgical repair of lacerations of the perineum, labia, or vaginal introitus− 9/15 were treated in the operating room, 6/15 were treated in the ED under conscious sedation. There were no urethral or rectal injuries. Two patients required post-operative Foley catheters to relieve urinary retention. There were no other complications. The gynecology service prescribed at least 1 medicated cream (bacitracin, estrogen, lidocaine) in all patients, with 2 or more creams used in 71% of patients. Patients treated solely by ED physicians were less likely to receive topical medical therapy than patients treated by the gynecology or surgical service (13/47, 28% vs. 22/22, 100% p<0.0001). No patients were readmitted for further management.
Conclusion:
Grade 1 and 2 straddle injuries are common and most often occur following a fall at home. Significant pain and/or bleeding requires specialty intervention for a careful exam under anesthesia or conscious sedation. The minority of patients (22% in this series) require surgical repair. Clear indications for surgery as well as indications and effectiveness of topical treatments will be most effectively answered in future, prospective trials.