Characteristics of children who had A History of genitourinary trauma and admitted to Akdeniz University Hospital between the years of 2015-2017

In our study, we aimed to determine the injury prevalence and demographic characteristics of children who admitted with history of genitourinary trauma, to evaluate the injuries in terms of forensic medicine, to review the issues to be considered in medicolegal aspects, and to remind the measures that can be taken. In this study, we had search for ICD-10 codes that may be related to the GUST in the Mia-Med Hospital Information Management System and evaluated the patients who were admitted to Akdeniz University Hospital with a history of genitourinary trauma between January 1, 2015 and December 31, 2015 retrospectively. There were 191 patients (0.14%) who admitted with a history of genitourinary trauma. We evaluated the characteristics of the patients such as time of injury, place of injury, other associated injury locations, injury type and findings, severity of injury in medicolegal aspects, frequency of reporting, and differences of cases according to report status. The children with a history of genitourinary trauma consisted of 87 (45,5%) girls and 104 (54,5%) boys. The mean age of the cases was 7,9 years (95,3 months, minimum 10 months and maximum 214 months). Genitourinary traumas has been most frequently reported in the age group of 4-7 years (48-95 months) (n:76, 39,8%), and 112 (58,6%) of the cases were under the age of 8 years. Most of the cases were admitted to the hospital in summer (n: 61, 31,9%), in August (n: 24, 12,6%), on Sunday (n: 38, 19,9%), between the hours of 06:00 pm until 11:59 pm (n:106, 55,5%). It was found that 58 (30,5%) of the genitourinary traumas occurred on a road / boulevard, 34 (17,8%) on a house and 14 (7,3%) on a playground / amusement park / sports area, but in 61 cases (31,9%), there isn't any information about the place of incident in the medical records. Injury types were blunt traumas in 157 (82,2%) cases, burns in 21 (11,0%) cases, and penetrating traumas in 6 (3,1%) cases. Seven (3,7%) cases were evaluated as the others. The most causes of genitourinary system traumas were falls in 75 cases (39,3%), traffic accidents in 56 cases (29,3) and burns in 21 cases (11,0%). It was found that 39 (52,0%) of the fall cases, fell from their own level and 31 (41,3%) fell from higher than their own level. In 5 cases (6,7%), there was no information about the height in their medical records. In cases of traffic accidents; bicycle accidents were recorded in 21 (37,5%) cases, motorcycle accidents in 12 (21,5%) cases, pedestrian accidents in 11 (19,6%) cases and in-car traffic accident in 11 (19,6%) cases. In one of the traffic accident cases, it was not specified whether pedestrians or others. In our study, bicycle accidents (n:21, 37,5%) were the largest group in traffic accidents which is different from the literature knowledge. Of the 21 burn cases, 19 had scald burns and 2 had flame burns. Of the cases with a history of genitourinary trauma, in 12 (6,2%) cases there were no physical signs, and in 21 (11,0%) of the cases had isolated hematuria, in 117 (61,3%) external genitalia injury, in 32 (16,8%) right and / or left kidney injury, in 5 (2,6%) external genitalia injury associated to the urethral injury, 3 (1,6%) cases had bladder injury and 1 (0,5%) case had injury of external genitalia, urethra and kidney injury at the same time. Fiftynine cases (30,9%) had hematuria, in which cases 16 of them were macroscopic and 43 of them had microscopic hematuria. It was found that the most common injured external genitalia were penis (n:27, %25,9) and scrotum (n:23, %22,1) in boys, labium majus (n: 20, 22,9%), labium minus (n: 18, 17,3%) and clitoris (n: 12, 11,5%) in girls. In injuries involving external genitalia, laceration (n:25) and ecchymosis (n:25) were the most common finding of injuries. Other common findings were abrasions (n: 23), incisions (n: 21), and burns (n: 21), respectively. It was found that 90,9% (n: 30) of the kidney injuries were caused by blunt traumas and 9,1% (n:3) of the cases were result of penetrating traumas. Kidney injuries were caused by mostly traffic accidents (n:18, 54,6%), and it was followed by falling (n:10, 30,3%), stabbing (n:2, 6,1%), firearm wound (n:1, 3,0%), collision (n:1, 3,0%) and squeeze (n:1, 3,0%). According to the medical files; 100 (52,4%) of all genitourinary system trauma cases were reported as the medicolegal case. In 41,3% of falls, in 73,2% of traffic accidents, in 42,9% of physical assaults, in 25,0% of crash / collision cases, in 20,0% of sports injuries, in 33,3% of the squeeze cases, in 50,0% of the sharp object injury cases, and in all cases of firearms wounds, stab wounds and flame burns, and in 52,6% of scald burns were reported as the medicolegal case. If the medico-legal assessment made by based on only the findings of the genitourinary system injuries; life-threatening injuries were in 40 (20,9%) of cases and injuries were incurable by simple medical intervention in 72 (37,7%) cases. Fifty-six (29,3%) cases were hospitalized in the wards and 26 (13,6%) cases treated in the intensive care unit due to their genitourinary injuries. Thirtytwo (16,8%) cases were operated because of their genitourinary system injuries. Pelvic fractures were seen in 14 (7,3%) cases. Of these cases 11 were traffic accidents, 1 was gunshot wound, 1 was fall, and 1 was squeeze injury caused fracture. In this study, anal / perianal trauma cases without genitourinary findings were evaluated separately and 12 cases were found. Of these cases, 5 (41,7%) were girls and 7 (58,3%) were boys and 4 of them were injured due to sexual abuse, 3 of them burns, 2 of them were falls from height, 2 of them falling on the pointed object and the last one injured with traffic accident. All of the children who have history of sexual abuse were men. In which cases the forensic case reporting rate was 66,7% (n:8). Only one of the patients who had a history of genitourinary trauma (n:191) (%0,5) and 3 (25%) of anal / perianal trauma cases were colsulted with Forensic Medicine Department. All of the genitourinary traumas in children should be carefully considered, and not overlooked since it may be life-threatening, may have severe results both physically and psychologically in the short and long term periods and needs differentiation from abuse. According to our study results, the most common cause of genitourinary traumas were falls, traffic accidents and burns. For this reason, taking necessary precautions to prevent these injuries and providing education to both parents and children on these issues (parental skills training, child safety skills, etc.) may help to reduce frequency of genitourinary traumas. Keywords: genitourinary trauma, child abuse, forensic medicine