Clinical Characteristics and In-Hospital Outcomes of Traumatic Bladder Rupture: An 11-Year Retrospective Cohort Study at a Single Regional Trauma Center

Background/Objectives: Traumatic bladder rupture often accompanies pelvic fracture, making it uncertain whether differences between extraperitoneal bladder rupture (EPBR) and intraperitoneal bladder rupture (IPBR) reflect the rupture site itself or overall trauma burden. Prior multi-institutional evidence has focused on EPBR. We therefore examined whether rupture site was associated with hospital length of stay after accounting for concomitant pelvic fracture and injury severity. Methods: We retrospectively reviewed 46 adults with definite traumatic bladder rupture treated at a single regional trauma center from January 2014 through December 2024. Rupture site was the primary exposure, hospital length of stay was the primary outcome, and intensive care unit (ICU) length of stay was the secondary outcome. Parsimonious exploratory log-linear models included rupture site, concomitant pelvic fracture, and Injury Severity Score (ISS). Results: Twenty-one patients had IPBR, 25 had EPBR, and 26 had concomitant pelvic fracture. In the adjusted primary-outcome analysis, rupture site was not clearly associated with hospital length of stay (EPBR versus IPBR adjusted ratio, 1.02; 95% CI, 0.59–1.76). The secondary adjusted analysis likewise showed no clear association with ICU length of stay (adjusted ratio for ICU days + 1, 1.31; 95% CI, 0.77–2.21). In unadjusted comparisons, pelvic fracture was observed more frequently with EPBR (72.0% versus 38.1%; p = 0.021; FDR q = 0.078), and EPBR was associated with longer hospital stay (median, 44.0 versus 24.0 days; p = 0.024; FDR q = 0.078) and ICU stay (8.0 versus 4.0 days; p = 0.007; FDR q = 0.037). Among 42 surgically treated patients, EPBR was associated with a longer admission-to-repair interval (adjusted ratio for days + 1, 2.21; 95% CI, 1.28–3.82). Conclusions: After adjustment for concomitant pelvic fracture and ISS, rupture site was not clearly associated with hospital or ICU length of stay. The conditional admission-to-repair finding may reflect complex trauma-care pathways rather than diagnostic delay. The frequent coexistence of bladder rupture and pelvic fracture reinforces the clinical importance of careful bladder assessment in patients with severe pelvic trauma.