Pediatric Vaginal Trauma: Variability In Evaluation And Management Across Free-Standing Pediatric Hospitals In The United States
PURPOSE There is currently no accepted standard of care or algorithm to guide the management of pediatric vaginal trauma. Prior studies are limited to single institution case series. We evaluated a large national database to identify frequency, associated injuries, and diagnostic procedures used in the evaluation and management of children with vaginal lacerations. MATERIAL AND METHODS We queried the Pediatric Hospital Information System (PHIS) database, an administrative database of 45 free standing pediatric hospitals in the United States. Inclusion criteria were female gender, age less than 17 years, and ICD-9 diagnosis codes for vaginal laceration (non-obstetrical) over 5 years. Variables evaluated were mechanism of injury, associated injuries and surgical management. RESULTS 5,664 children with vaginal lacerations were identified. Patient characteristics: age 3-7 years (61%), Caucasian (63%), Medicaid (39%). There was no difference in management based on age, race or payer. Most common mechanisms of injury: person versus object (16%), home accidents (14%), and sexual assault (12%). 6% of patients had underlying urogynecologic anomalies. Associated injuries were rare, but when identified, included: injuries to head and face (2%), upper/lower extremity (4%), cardiothoracic (7%), abdominal (2%). When performed, diagnostic procedures included: vaginoscopy (2%), cystourethroscopy (0.5%), anoscopy or colonoscopy (0.8%). CONCLUSIONS This is the first large multi-institutional study of vaginal injuries in children. Compared to published case series, this study suggests across the nation in children's hospitals many associated injuries may be missed due to a lack of a standardized diagnostic approach to vaginal trauma.