- Blunt abdominal trauma is proportionally more common in children and results in more injuries and deaths than penetrating trauma. However, penetrating trauma is far more lethal as a sole injury.
- Management of pediatric abdominal trauma requires a coordinated effort between the emergency physician, trauma surgeon, and pediatric referral center.
- The spleen and liver are the most commonly injured organs as a result of blunt abdominal trauma. Liver injuries constitute the most common cause of death.
- Care must be taken not to let the head and extremity components of Waddell's triad divert attention from the more subtle findings of intra-abdominal injury that may include life-threatening hemorrhage.
- Computed tomography (CT) scan has eliminated much of the difficulty surrounding the diagnosis of abdominal injuries and is the procedure of choice for stable pediatric trauma patients. However, CT scan is not without risk and must be used judiciously using the ALARA standard (as low as reasonably achievable).
- The focused abdominal sonography for trauma (FAST) ultrasound examination evaluates up to six areas of the abdomen with the principal objective of identifying hemoperitoneum. The FAST examination is less sensitive in children than adults.
- Perforations of the duodenum and proximal jejunum are the most common intestinal injuries and are usually associated with lap belt or bicycle handlebar injury.
Trauma is the most common cause of death in children. Abdominal trauma accounts for close to 200 000 visits to US emergency departments each year.1 Serious abdominal injuries are relatively common in childhood and account for approximately 8% of admissions to pediatric trauma centers. Only 15% of these injuries require surgery and the majority of these are for penetrating wounds. Abdominal trauma is the third leading cause of traumatic death behind head and thoracic injuries, but it is the most common unrecognized cause of fatal injury in children.
Blunt abdominal trauma is proportionately more common in children and results in more injuries and deaths than penetrating trauma. Blunt trauma accounts for 85% of pediatric abdominal trauma (vs. 50% in adults) with 9% of these patients dying primarily from associated injuries. Yet penetrating trauma is far more lethal as the sole injury. Penetrating abdominal trauma accounts for only approximately 15% of the total cases, and of these 6% will die primarily from the penetrating wound. Children are susceptible to different injury patterns than adults. Blunt trauma from motor vehicle collisions causes more than half of the abdominal injuries seen in children and is the most lethal. Penetrating injuries in the pediatric population are increasing. Gunshot and stab wounds are particularly common in young adolescents and 75% are inflicted by an assailant as opposed to accidental shootings that occur most commonly from firearms discovered by children in the home. Accidental impalement occurs more often in children younger than 13 years and these injuries may involve such diverse items as scissors or picket fences.
Management of pediatric abdominal trauma requires a coordinated effort between the emergency physician, trauma surgeon, ...