This guideline is not intended to address the care of pediatric patients or pregnant women. The use of a pediatric abdominal trauma protocol improves. It is also the most common unrecognized fatal injury in the pediatric population. Trauma is a physical injury caused by transfer of energy to and within the person involved. Identifying children at very low risk of clinically. Blunt abdominal trauma is more common than that of penetrating abdominal trauma, and the mechanisms of injury vary among the different age groups. Identify stateoftheart treatment modalities and management for various injuries. Pediatric abdominal trauma is the 3 rd leading cause of death. Computerized tomography scan for paediatric abdominal trauma was first described in 1980 and remains the investigation of choice. Trauma is the leading cause of death and disability in the pediatric population. Sep 14, 2019 assessment of abdominal trauma requires the identification of immediately lifethreatening injuries on primary survey, and delayed life threats on secondary survey. Since most of the children with blunt trauma are managed expectantly, timely diagnosis is imperative to avoid morbidity and mortality. I have no financial conflicts of interest to disclose. Good morning music vr 360 positive vibrations 528hz the deepest healing boost your vibration duration.
Identifying children at very low risk of clinically important. Selection of participants children with blunt torso thorax and abdomen trauma evaluated in the emergency department ed at any of 20. The liver is the second most commonly injured intra abdominal organ in children. However, the risks associated with performing ct in children are not insignificant and, in addition, ct is not always readily available. The risk of intra abdominal injuries in pediatric patients with stable blunt abdominal trauma and negative abdominal computed tomography. Use of oral contrast in ct evaluation of pediatric blunt. The goal of this scenario is to provide the learner with an opportunity to manage pediatric blunt abdominal trauma with hemorrhagic shock, where the correct steps need to be taken in a limited period of time. Trauma remains the number one cause of disability and death for children. The incidence of pediatric blunt abdominal injury is approximately 91 lakh children. Nonoperative management of pediatric blunt abdominal injury has changed significantly in the last few years. 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. Significant intra abdominal injury after blunt torso trauma highly unlikely 0. Children hide hemodynamic instability from hemorrhage. No thoracic wall trauma or decreased breath sounds.
Blunt abdominal trauma in children request pdf researchgate. Blunt abdominal trauma american academy of pediatrics. Other mechanisms of blunt abdominal trauma include falls, sports, and recreation. 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. 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. As there is a broad spectrum of abdominal injuries, abdom. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured.
Use of laparoscopy in the management of pediatric abdominal trauma. In the pediatrie age group, 17 years and under, it is not only. The use of angiography in pediatric blunt abdominal trauma p. 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. Duodenal haematoma is a relatively common complication of blunt abdominal trauma, including nonaccidental child abuse. Colletti, mdb, donald van wie, doc aemergency medical services, blackfeet community hospital, po box 760, browning, mt 59417, usa bemergency medicine regions hospital, 640 jackson street, st.
Pdf clinical recognition and management of pediatric. Solid organs, seatbelts, and sieverts tucker redfern symposium 2018 ramin jamshidi, md facs 23 march 1965. Pediatric abdominal trauma is common, with delays in diagnosis and treatment. According to the cdc vital statistics reports, blunt trauma remains the leading cause of death and disability in children. Blunt abdominal trauma bat is frequently encountered in the form of motor vehicle crashes mvcs 75%, followed by falls and direct abdominal impact. Isolated duodenal perforation idp in pediatric trauma is rarely reported. The clinical evaluation of children with potential blunt abdominal injury presents a challenging task. Imaging guidelines in pediatric trauma jon ryckman, md, facs medical director, pediatric trauma sanford children s hospital.
Oral contrast agents for ct of abdominal trauma in pediatric patients. An isolated duodenal perforation in pediatric blunt abdominal. Oct 17, 2019 marwan a, harmon cm, georgeson ke, smith gf, muensterer oj. Pediatric blunt abdominal trauma stephen wegner, mda,t, james e. Specific management depends on whether trauma is penetrating or blunt and on whether solid or hollow organs are injured. No abdominal tenderness, abdominal pain, or vomiting. Mir scrapped the plan solid organ injuries seatbelt trauma abdominal imaging core principles key publications discussion scope of the problem soi. Abdominal sonography in examination of children with blunt. Pediatric blunt abdominal trauma emergency medicine. 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. Car lower extremity fx, thoracicupper abdominal traumahead trauma bike accident headortho handlebar injuriesshearing of abdominal wall away from skin handlebar hernia, pancreas and duodenal injuries mva with lap belt worn too high seat belt injury. Ppt abdominal trauma powerpoint presentation free to.
No evidence of abdominal wall trauma or seat belt sign. Penetrating injuries are less common but often require operative management. Blunt abdominal trauma accounts for the large majority of abdominal. Jul 31, 2019 children are more vulnerable to blunt abdominal injury than adults because they have see trauma management. Blunt abdominal injuries often managed conservatively, though. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus nonoperative management. Abdominal trauma is a major cause of severe injury in children and also is the most common cause of initially missed fatal injury. Blunt abdominal injury is the third most common cause of trauma mortality in children. Blunt abdominal trauma is a common problem in children. 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. Key elements include the primary survey, eliciting critical history fall from 3. Selection of participants children with blunt torso thorax and abdomen trauma. Blunt abdominal injury the eastern association for the.
An isolated duodenal perforation in pediatric blunt. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Stony brook university medical center stony brook, ny pediatric blunt abdominal trauma. Compact torso with large organ to body mass ratios concentrated in a tight abdomen. Contrast enhanced ultrasound for the evaluation of blunt.
It is divided into two types blunt or penetrating and may involve damage to. In australia blunt trauma accounts for 90% of admitted trauma cases, 22% of whom sustain a blunt abdominal trauma bat 1. The spleen is the most common organ injured following blunt abdominal trauma. Pediatric blunt spleenliver trauma management 89 pediatric blunt renal trauma management 140141 pediatric extremity fracture 142143 pediatric pelvic fracture 144145 pediatric vte 146147 upper extremity and digit replantation 148149 social work consults screening 150 suspected child abuse and neglect 151 pediatric trauma pearls 152. 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 emergency care. The original paper describing the validity of ct scanning for the assessment of children with abdominal trauma. Describe common mechanisms for pediatric trauma and injury patterns. Pediatric emergency medicine simulation curriculum. Stony brook university medical center stony brook, ny. The assessment and treatment of children with specific injuries to. Pediatric abdominal trauma is common, with delays in diagnosis and treatment resulting in an increased rate of complications. It has been shown that nonoperative treatment of children with blunt abdominal trauma is successful in more than 95% of appropriately selected cases if trauma care providers have a thorough knowledge of the anatomy and physiology of the growing child. Abdominal trauma is classified as blunt or penetrating, assessment and management is modified accordingly.
The use of computerized axial tomography and nonoperative management of haemoperitoneum are two significant. Surgeons, emergency medicine, pediatricians learning objectives. Mar 01, 2008 according to the cdc vital statistics reports, blunt trauma remains the leading cause of death and disability in children. Trauma is a leading cause of morbidity and mortality in children. Pressure bags can increase the likelihood of excessive fluid overload. Gastrointestinal injuries from blunt abdominal trauma in children. Knowledge of specific mechanisms of injury aids the clinician in the diagnosis of specific injuries.
In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma bat in children. Click on the image or right click to open the source website in a new browser window. This article discusses abdominal trauma in children. Only isolated cases of idp following blunt abdominal trauma exists in the english literature 24. Can cause decapitation in young children severe face, chest and abdominal injuries the safest place for a child is in a car seat in the back seat of the car. The objective of our study was to evaluate abdominal sonography for the detection of fluid and organ injury in children with blunt abdominal trauma. Yet most injured children are cared for by providers who do not have extensive experience in pediatric trauma. They did elegant studies comparing ct, angiogram, and ivp. Trauma clinical guideline evaluation and management of blunt abdominal trauma the trauma medical directors and program managers workgroup is an open forum for designated trauma services in washington state to share ideas and concerns about providing trauma care. Nov 01, 20 motor vehiclerelated injuries, whether as vehicle occupants, bicyclists, or pedestrians, are the most common cause of pediatric blunt abdominal 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. The assessment and treatment of children with specific injuries to the spleen, liver, pancreas, gastrointestinal tract or genitourinary tract are discussed separately. Abdominal ultrasound in pediatric trauma patients american. In infants and children aged 04 years, abuse accounts for at least 15% of blunt abdominal injuries, and, excluding injuries caused by motor vehicle traumatic abdominal injuries that require hospitalization in this age group 2,3. Complications may include blood loss and infection diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery. Abdominal trauma is seen quite often in the emergency department and can result from blunt or penetrating mechanisms. Mechanism of injury consideration of the cause of blunt pediatric abdominal trauma has been a major decision point for pediatric trauma system activation and deciding how to evaluate a child for potential iai. The mechanism of injury dictates the diagnostic workup. Pediatric annals injury in individuals 44 years of age and under continues to be the leading cause of death in the united states. Blunt abdominal trauma accounts for more than 90% of all pediatric injuries and constitutes an important cause of morbidity and mortality in this age group. 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. Pediatric blunt abdominal trauma request pdf researchgate.
Fiftyone consecutive children with blunt abdominal trauma requiring abdominal ct were prospectively examined with sonography. In tropical africa, it is only beginning to assume importance as infections and malnutrition are controlled. Additionally, abdominal injury in nat is frequently severe. Concomitant injuries are more common, and overall outcome depends on the. Infants and small children should always receive resuscitation fluids using a pump or push to allow for observation and control of fluid delivery. Blunt abdominal trauma evaluation and management guideline. We report a case of idp and emphasize on certain specific clinical features indicating possibility of duodenal injury. Relatively compact torsos with smaller anteriorposterior diameters, which provide a smaller area over which the force of injury can be dissipated.
Abdominal trauma is best categorized by mechanism as blunt or penetrating abdominal injury. Computed tomography ct is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of cts are normal and ct carries a risk of radiationinduced cancer. The sonographic findings of duodenal haematoma are similar to those in henochschonlein purpura and include bowel wall thickening with a varying echotexture depending on the age of the haematoma. Motor vehiclerelated injuries, whether as vehicle occupants, bicyclists, or pedestrians, are the most common cause of pediatric blunt abdominal trauma. To evaluate the initial workup and design a score that would allow ruling out significant intra abdominal organ injuries following blunt abdominal traumas bat. Ct scanning is currently regarded as the gold standard in screening for intra abdominal injury following blunt trauma. These images are a random sampling from a bing search on the term pediatric blunt abdominal trauma. Blunt abdominal trauma in pediatrics 201101 ahc media. Children are more susceptible than adults to serious injury secondary to blunt abdominal trauma. Nationwide, many practitioners care for children who face this.
This guideline is intended for nonpregnant adult patients presenting to the emergency department with acute, blunt abdominal trauma. Computed tomography of blunt abdominal trauma in children visrutaratna p, na chiangmai w abstract computed tomography ct plays a major role in diagnosis of blunt abdominal trauma of haemodynamicallystable children. Pediatric population size small size increased energyunit surface area less fatsoft tissue high frequency of multiple organ injury skeleton less calcified therefore more flexible greater incidence of abdominal, chest and spinal cord injury without fracture. The abdomen is the second most common site of injury. Children are higher risk for serious injury following blunt abdominal trauma. When a pediatric patient presents to the ed following blunt abdominal trauma, the abdominal examination may be unreliable due to the childs age or developmental level, or due to an associated head injury. Trauma is the leading cause of death in children in developed countries. Nonoperative management is employed in over 95% of patients. Data were collected prospectively from 147 consecutive patients admitted for bat in a. Computed tomography of abdominal trauma 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. Fluid resuscitation is an important component of the management of abdominal injuries in children. Pediatric blunt abdominal trauma peacehealth novel coronavirus covid19 information for patients, visitors and medical professionals. Blunt abdominal trauma 60 blunt splenic trauma 6162 blunt bowel and mesenteric injury 6364 rectal injury 65 pelvic fracture 6667 peripheral vascular injury 6869. 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.
We also stress upon the role of early contrastenhanced. Pediatric blunt abdominal trauma evidence of abdwall trauma or seatbelt sign, andor gcs trauma have become an important obstetric concern. The purpose of this study was to determine the incidence of angiography in the treatment of blunt abdominal trauma among injured children. Performance of abdominal ultrasonography in pediatric blunt trauma patients. In this article we discuss key issues to help clinicians efficiently and successfully evaluate and manage blunt pediatric abdominal trauma. Evaluation of abdominal trauma differential diagnosis of. A protocol was developed to monitor pregnancies complicated by major blunt abdominal trauma in the third trimester, looking specifically for delayed placental andor fetal problems. Pdf blunt abdominal trauma in children researchgate. A free powerpoint ppt presentation displayed as a flash slide show on id. Fiftyone consecutive children with blunt abdominal trauma requiring abdominal ct. Request pdf pediatric blunt abdominal trauma blunt pediatric trauma is a major threat to the health and wellbeing of children. Assessment of abdominal trauma requires the identification of immediately lifethreatening injuries on primary survey, and delayed life threats on secondary survey. New decision tool for pediatric blunt abdominal trauma.
398 1644 1542 62 678 127 1445 207 1294 1596 286 692 309 1318 782 1592 574 1452 1580 1363 692 166 1112 1479 181 135 1497 366 684 925 1230 530 140