1. Pediatric Blunt Abdominal Trauma
Sabrina Sanchez, MD, MPH
December 20th, 2012

2. Epidemiology Trauma is the leading cause of childhood death
Boys are injured twice as often as girls
Blunt abdominal trauma occurs in 10-15% of injured children
Vyrostek, MMWR Surveill Summ 2004
Gaines, J Trauma 2009
Wilson, Injury 1992

3. Blunt Trauma and Pediatric Anatomy
Children are smaller
More concentrated impact
Children have less calcified bones and more elastic tissues
Fewer broken bones
Occult organ damage
Children have increased surface area to volume ratio
Rapid dehydration and hypothermia
Abdominal wall is thin and less muscular
Liver and spleen are located lower in the abdomen and are relatively large
Compact torsos and smaller AP diameter
No external signs of injury

4. Pediatric Trauma Biomechanics
Most pediatric injuries result from blunt force
Liver and spleen injuries are the most common intrabdominal injuries in children who sustain blunt trauma

5. How do we evaluate children with blunt abdominal trauma accurately and safely?
Minimizing radiation
Not missing any injuries

6. Published in 2002. Children <16 at a major level 1 trauma center sustaining blunt trauma.
Intrabdominal injury= spleen, liver, pancreas, kidney, adrenal glands or GI tract.
Enrolled 1095 patients and 107 (10%) had intrabdominal injuries

8. Clinical Variables Age Systolic blood pressure Abdominal tenderness
Thoracic examination
Pelvic examination
Femur fracture
GCS score
Urinalysis
Initial hematocrit
Serum hepatic transaminase concentrations

16. 365 CT scans would have been avoided!

17. Know Your Vital Signs AGE GROUP WEIGHT RANGE (kg) HR (beats/min) SBP
(mm Hg) RR
(breaths/min)
Infant 0–1
0–10
<160
>60
<60
Toddler 1–3
10–14
<150
>70
<40
Preschool 3–5
14–18
<140
>75
<35
School age 6–12
18–36
<120
>80
<30
Adolescent >12
36–70
<100
>90
ATLS, 8th edition

18. High Risk Mechanism MVC with ejection or death of occupant in vehicle
MVC with intrusion >12 inches into patient compartment or >18 inches into any compartment
Auto vs. pedestrian
Auto vs. bike with significant impact
MCC >20mph or with separation of rider from motorcycle
Fall >10 ft or 2-3x the patient’s height

19. High Risk for Blunt Abdominal Trauma
Direct blow to the abdomen
Complaint of abdominal or flank pain
Tenderness on abdominal exam
Seat belt sign or handle bar mark
Suspected pelvic fracture
Lower rib fractures
Unknown mechanism with altered level of consciousness

20. Injury Management
Non-operative management of blunt spleen and liver injury is successful in 90% of children
Treatment modality in hemodynamically stable patients irrespective of the grade of injury
Indications for operative management include ongoing blood loss and hemodynamic instability
Trend towards transfusing hemodynamically stable patients with ongoing bleeding
Alonso, East 2003
McVay, J Pediatr Surg 2008

21. Stylianos and the APSA Liver/Spleen Study Group, J Pediatr Surg 2002