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OVERVIEW

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Abdominal trauma is the most common unrecognized fatal injury and the third leading cause of pediatric trauma death after injuries to head and thorax. The mortality rate is estimated to be as high as 8.5% and accounts for 8-12% of all deaths of children admitted with abdominal trauma.

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Children have anatomic, physiologic, and psychological characteristics in contrast to adults that predispose them to a variety of injuries. Recognition of these characteristics plays a major role in the evaluation and management of pediatric trauma patient. The most pertinent characteristics related to abdominal trauma are outlined in (Table 26–1).

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Table 26–1.   Reasons for pediatric susceptibility in trauma. 
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TYPES OF INJURY

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BLUNT ABDOMINAL INJURY

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More than 80-90% of traumatic abdominal injuries in children result from blunt mechanism. The most common causes of injury are traffic accidents (49%), falls (22%), direct impact trauma (20%), and being run over by a vehicle (9%). Other mechanisms include all-terrain vehicle (ATV) accidents, handlebar injuries from bicycles, and sport or non-accidental trauma. Incidences of solid organ injuries associated with blunt trauma are spleen (46.7%), liver (33.3%), renal (17.5%), and pancreas (2.5%).

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Children with non-accidental trauma have the highest risk for morbidity and mortality.

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PENETRATING INJURIES

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Penetrating abdominal trauma accounts for 4-15% of all pediatric abdominal trauma. In the United States, firearm-related injury and gunshot wounds (GSWs) are the most common causes of penetrating injuries ...

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