Blunt abdominal trauma in pediatrics 201101 ahc media. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Mechanism of injury often reflects the age and developmental status of the child. This guideline is intended for nonpregnant adult patients presenting to the emergency department with acute, blunt abdominal trauma. Recent findings improved resource utilization in the diagnosis of pediatric abdominal injury has been described. Defining a concerning fast exam in pediatric blunt abdominal. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Pdf management of kidney injuries in children with blunt. The use of computerized axial tomography and nonoperative management of haemoperitoneum are two significant. The use of angiography in pediatric blunt abdominal trauma p. Blunt trauma to the abdomen american academy of pediatrics. Identifying children at very low risk of clinically.
Management of blunt abdominal injury in children was restructured using an algorithm suggested by the american pediatric surgical association apsa trauma committee to coordinate care at a regional trauma center. Pediatric blunt abdominal trauma university of new mexico. Nonoperative management of pediatric blunt abdominal injury has changed significantly in the last few years. Identifying children at very low risk for blunt intraabdominal injury in whom ct of the abdomen can be avoided safely. This guideline is not intended to address the care of pediatric patients or pregnant women.
Computed tomography for pancreatic injuries in pediatric. Fiftyone consecutive children with blunt abdominal trauma requiring abdominal ct were prospectively examined with sonography. Mvas are the most common cause of blunt abdominal trauma, causing about 75% of such injuries. The objective of our study was to evaluate abdominal sonography for the detection of fluid and organ injury in children with blunt abdominal trauma. You are called to a sports field where a 6yearold girl has been struck wit h a hockey stick. We report a case of idp and emphasize on certain specific clinical features indicating possibility of duodenal injury. Data were collected prospectively from 147 consecutive patients admitted for bat in a.
Concomitant injuries are more common, and overall outcome depends on the. The purpose of this study was to determine the incidence of angiography in the treatment of blunt abdominal trauma among injured children. Describe common mechanisms for pediatric trauma and injury patterns. In children less than or equal to 14 years of age, blunt abdominal trauma is the second most frequent cause of mortality preceded by head injuries.
Pediatric annals injury in individuals 44 years of age and under continues to be the leading cause of death in the united states. Chapter 10 does ct scan for blunt abdominal trauma in children. An understanding of the unique epidemiology of pediatric trauma allows for the provision of optimal care for injured children. Pdf injury and risk of abdominal trauma in children. Abdominal trauma is the main culprit of serious children s injury and the most common area of initially missed diagnosis with a fatal outcome. The use of computerized axial tomography and nonoperative management of. Stony brook university medical center stony brook, ny. Management of kidney injuries in children with blunt abdominal trauma. Trauma is the leading cause of death and disability in the pediatric population.
Based on the low sensitivity of the ct, the authors suggest diagnostic peritoneal lavage may offer advantages over ct as the initial study in the evaluation of children with blunt abdominal trauma. Advances in technology have made evaluation of intra abdominal injuries increasingly less invasive, but clinical diagnosis and an appropriate level of suspicion are still the most important variables in management. The use of angiography in pediatric blunt abdominal trauma. Children are more susceptible than adults to serious injury secondary to blunt abdominal trauma. Approximately 90% of abdominal trauma is blunt and 10% is penetrating. Pediatric trauma assessment objectives recognize the distinctive features of global management of the child with trauma. The indications for imaging after blunt trauma are physical examination or laboratory findings suggestive of abdominal injury including hematuria, abdominal bruising or ecchymosis, abdominal distention, abdominal pain, absence of bowel sounds, vomiting, decreased hematocrit, and blood from the rectum or nasopharyngeal tube aspirate. Pediatric abdominal and thoracic trauma synonyms blunt abdominal trauma, penetrating abdominal trauma, blunt chest trauma, penetrating chest trauma, stab wound to abdomen chest, liver laceration. Causes of blunt abdominal trauma include motor vehicle accidents mvas, motorcycle crashes mccs, pedestrianautomobile impacts, falls, and assaults. After failure to control the airway, blunt abdominal trauma bat is the second most frequent cause of preventable death in pediatric trauma patients evaluation of pediatric bat can be challenging external signs may be few physical examination can be unreliable ct is overutilized and poses radiation risk. Major blunt trauma to the abdomen frequently is associated with this series of injuries. The use of a pediatric abdominal trauma protocol improves. The fast examination for children with abdominal trauma. Pediatric trauma is a leading cause of morbidity and mortality rapid, appropriate interventions are lifesaving and can prevent morbidity advanced imaging in pediatric trauma is not without risk and should only be used when the benefit outweighs the risk.
Blunt abdominal injury is the third most common cause of trauma mortality in children. Oct 17, 2019 trauma is the leading cause of morbidity and mortality in the pediatric population. The close proximity of organs within the torso makes distinguishing between abdomen, chest and pelvic injuries difficult. Implications of a negative abdominal ct in the management of. Although the abdominal ct scan is useful in evaluating children with blunt abdominal trauma, a number of significant injuries were missed. The clinical evaluation of children with potential blunt abdominal injury presents a. Trauma is the leading cause of death in the pediatric population, and injuries to the abdomen are the third leading cause of pediatric trauma death, after injuries. Identifying children at very low risk of clinically important. The purpose of this study was to evaluate the impact of ct on operative management of children examined after blunt abdominal trauma. Only isolated cases of idp following blunt abdominal trauma exists in the english literature 24. Isolated duodenal perforation idp in pediatric trauma is rarely reported. Abdominal trauma is usually divided into blunt and penetrating trauma.
Since most of the children with blunt trauma are managed expectantly, timely diagnosis is imperative to avoid morbidity and mortality. Blunt abdominal trauma accounts for the large majority of abdominal injuries. We also stress upon the role of early contrastenhanced. Chapter 7 paediatric blunt liver trauma in a dutch level 1 trauma center. In the setting of blunt abdominal trauma, the zones have been attributed to dissection of blood along the portal tracts. The purpose of this study is to present the radiological pattern of pediatric pancreatic injuries caused by blunt abdominal trauma, as diagnosed by abdominal ct scan in a tertiary hospital. Evaluation of the acutely injured pediatric patient is challenging and is often limited by factors which include alteration in mental status and difficulty communicating with. Streck cj, vogel am, zhang j, huang ey, santore mt, tsao k, falcone ra, dassinger ms, russell rt, blakely ml. Blunt abdominal trauma american academy of pediatrics. Abdominal trauma is present in approximately 25% of pediatric patients with major trauma and is the most common cause of unrecognized fatal injury in children. Many serious abdominal injuries may appear insignificant, making it extremely difficult to predict severity. All clinicians who care for children with potential blunt abdominal injuries should be aware of current concepts related to the diagnosis and treatment of pediatric blunt abdominal trauma.
In a randomized clinical trial rct of the focused assessment with sonography for trauma fast examination in stable children with blunt abdominal trauma compared with standard evaluation, dr holmes and colleagues 1 found no difference in coprimary outcomes, including computed tomography ct use. Blunt abdominal trauma accounts for the large majority of abdominal injuries in the pediatric population. Penetrating and blunt trauma to the abdomen can produce significant and lifethreatening injuries. Blunt abdominal trauma is a common presentation in the emergency unit and still remains a leading cause of death in children older than one year of age. Blunt abdominal trauma is the commonest cause of intra abdominal injuries in children. Rather than removing fast examinations from pediatric trauma algorithms, the results of the clinical trial by holmes et al should encourage the trauma, pediatric emergency medicine, and ultrasound communities to work together to further investigate the many unresolved questions about integrating fast examinations into pediatric blunt abdominal. Blunt abdominal trauma in the pediatric patient sciencedirect. This is a difficult injury to evaluate because often there are few signs of external damage to reflect the lifethreatening trauma to internal abdominal organs. Blunt abdominal injuries often managed conservatively, though interventional radiology and surgery are indicated for severe injuries. The committee on trauma of the american college of surgeons has recently advocated for this resource to be urgently available at pediatric trauma centers. No consensus exists on management of children with a negative trauma ct following blunt abdominal trauma bat.
Asymptomatic children are frequently admitted for observation following negative ct owing to concerns about missing an intraabdominal injury iai without evidence for this practice. Name the most common traumatic injuries among children. Student course manual, 9th ed, american college of surgeons committee on. Background angiography is a common treatment used in adults with blunt abdominal trauma andor severe pelvic fractures. Pdf genitourinary injuries in pediatric blunt trauma. Blunt abdominal injury the eastern association for the. Selection of participants children with blunt torso thorax and abdomen trauma evaluated in the emergency department ed at any of 20. Any signs of circulatory compromise, especially with a history suggestive of abdominal injury, should prompt assessment of the abdomen and pelvis as part of circulation in the primary survey. A solid foundation in pediatric abdominal trauma is essential for all emergency medicine physicians. Common mechanisms include road traffic crashes, falls, sports injuries and assaults. Findings of abdominal trauma haemoperitoneum splenic trauma. Blunt torso injury in children 90% of children with solid organ injury stop bleeding and are managed conservatively ct scan of abdomen, chest and head are the usual screening studies done in children with potentially severe injury remember the possibility of hollow viscus injuryparticularly with seat belts. External bleeding is easily detected and controlled with manual. Although this age group is included in studies that addressed pediatric blunt abdominal trauma, preverbal children are underrepresented and not specifically substratified.
Assess children with trauma according to specific priorities. Trauma is the leading surgical cause of morbidity and mortality in pediatric population, and the abdomen is the third most commonly injured anatomic region in children, after the head and the. Each year approximately 600,000 children in the united states are hospitalized for trauma related injuries, and approximately 2030% of these injuries involve the abdomen. Computed tomography in the evaluation of children with. Nonoperative management of pediatric blunt abdominal injury has changed significantly in. Blunt trauma in paediatric patients experience from a. Pdf blunt abdominal trauma in children researchgate. Pediatric abdominal trauma is common, with delays in diagnosis and treatment resulting in an increased rate of complications. Pediatric abdominal and thoracic trauma cancer therapy. Evaluation of abdominal trauma differential diagnosis of. Abdominal sonography in examination of children with blunt. Nonoperative management is employed in over 95% of patients.
The provider must consider the mechanism of trauma in assessing risk of injury. Blunt abdominal trauma in children emergency management. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Trauma is the leading surgical cause of morbidity and mortality in pediatric population, and the abdomen is the third most commonly injured anatomic region in children. Pitfalls of nonoperative management of blunt abdominal trauma in children in korea. In the pediatrie age group, 17 years and under, it is not only. To evaluate the initial workup and design a score that would allow ruling out significant intra abdominal organ injuries following blunt abdominal traumas bat. The most common mechanism of abdominal injury in children is blunt trauma, often as a result of a motor vehicle injury mvi 9, 30, 32, 39. Most abdominal injuries in children are caused by blunt, rather than penetrating, trauma. At the royal melbourne hospital in 2016, bat accounted for 15% of all major trauma cases, of these 30% required a laparotomy and 18% required angioembolisation 2. According to the cdc vital statistics reports, blunt trauma remains the leading cause of death and disability in children. New decision tool for pediatric blunt abdominal trauma. Up to 90% of these injuries are as a result of blunt trauma 1. Overall, blunt trauma accounts for more than 90% of all pediatric injuries, and this is true for abdominal injuries as well.
The purpose of this study was to determine the incidence, aetiology, grades of abdominal organ injuries, diagnosis, management and outcome of blunt abdominal trauma in a paediatric population. Fifteenhundred consecutive children who sustained blunt abdomin. Methods an analysis was performed using an established public use data set of children younger than 18 years treated at 20 participating trauma centers for blunt torso trauma through the pediatric. Injury is the leading cause of morbidity and mortality in children over one year of age and accounts for over 60% of childhood deaths.
The abdomen is the second most common site of injury. Look for specific signs, such as seatbelt or handlebar marks in the upper abdomen. In children, about 75% of trauma occurs on the roads and the majority of these involve blunt trauma with most children sustaining multiple injuries. An isolated duodenal perforation in pediatric blunt abdominal. Sep 14, 2019 abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly. The use of a pediatric abdominal trauma protocol improves resource utilization bindi naikmathuria md, sara fallon md, fariha sheikh md, mary frost rn, daniel christopher rn, david delemos md divisions of pediatric surgery and pediatric emergency medicine trauma services, texas childrens hospital baylor college of medicine, houston, tx. The role of focused abdominal sonography for trauma fast in pediatric trauma evaluation. It is also the most common unrecognized fatal injury in the pediatric population to manage these patients effectively, physicians must be very familiar with children s response to abdominal trauma, recognize important sensory cues and avoid common pitfalls. This article discusses abdominal trauma in children. In children, blunt trauma is responsible for 90% of renal injuries, and the kidney is injured in approximately 10% of all pediatric blunt abdominal trauma. Blunt abdominal trauma in children request pdf researchgate.
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