(24) Characterization of Pediatric Female Genital Trauma Using a Novel Grading System and Recommendations for Management

Background: There is no standardized grading system or protocol for management of pediatric female genital trauma (PFGT). Rates of operative intervention among large multi-center database studies vary considerably.

Methods: Retrospective review of female patients < 19 years presenting to our American College of Surgeons-verified Level 1 pediatric trauma center with genital trauma between 1/2018-12/2022. Patient demographics, injury characteristics, and interventions were recorded. Summary statistics were calculated. A novel grading system to classify PFGT injuries was developed in conjunction between pediatric surgery and pediatric & adolescent gynecology.

Results: 353 patients met inclusion criteria, with median age of 6.4 years (Interquartile range: 4.2,8.6). Straddle injuries were most common (76.1%), followed by non-straddle blunt injuries (11.8%). Most patients had low-grade injuries. Following bedside evaluation, 65.6% of injuries were discharged with expectant management and did not require suture repair. Among patients transferred to our center from another facility, 54.1% required no further intervention at our center. Those requiring intervention underwent general anesthesia (83.6%) for sedation, most commonly for either an exam under anesthesia without suture repair (18.6%) or single-layer suture repair (48.0%). Median operative time for all injuries was 15.0 minutes (IQR: 9.0, 22.0). Few patients (16.4%) were repaired under procedural sedation or local anesthesia.

Conclusions: We propose a standardized grading system and algorithm to guide appropriate management of female genital trauma. There are significant potential cost savings if admission and OR utilization can be avoided, and healthcare resources used more appropriately. Grade 1 and 2 injuries can be managed without surgical consultation, as do not require suture repair. Surgical consultation is recommended for higher grade injuries, however given the typical short operative times and single-layer closure, strong consideration should be given to repair with bedside sedation when resources allow.