Blunt abdominal trauma is proportionally more common in children and results in more injuries and deaths than penetrating trauma.
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.
Computed tomography (CT) scan provides diagnoses of abdominal injuries. However, CT scan is not without risk and must be used judiciously using the as low as reasonably achievable (ALARA) standard.
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 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 in children. Blunt trauma accounts for 85% of pediatric abdominal trauma. Penetrating abdominal trauma accounts for approximately 15% of the total cases and 6% of these will die primarily from the penetrating wound.
Children are susceptible to different injury patterns than adults. Blunt trauma from motor vehicle collisions (MVCs) causes more than half of the abdominal injuries and is the most lethal. Penetrating injuries in the pediatric population are increasing, particularly in young adolescents. Accidental impalement occurs more often in children younger than 13 years and 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, and pediatric referral center. Immediate stabilization and transfer of the most severely injured children to an appropriate trauma center when indicated will result in greatly improved outcomes.2,3
Multisystem trauma, along with abdominal injury, is common when an automobile strikes a child (Table 27-1). Waddell’s triad (Fig. 27-1) demonstrates a pattern of pediatric pedestrian injury with impact first to the upper leg, then chest and abdomen, followed by head. The head and extremity components of Waddell’s triad should not divert attention from intra-abdominal injury that may include life-threatening hemorrhage. In countries in which motorists drive on the right side of the road, the most common injuries are on the left side, as children are often struck crossing the street, and frequently result in splenic injuries.
TABLE 27-1Patterns of Injury by Mechanism |Favorite Table|Download (.pdf) TABLE 27-1 Patterns of Injury by Mechanism
|Waddell’s Triad ||Lap Belt Complex ||Fall from a Height |
|Pedestrian mechanism in child ||Restrained occupant in MVC || |
|Midshaft femur fracture ||Blowout diaphragm injury ||Head ...|