Complications may include blood loss and infection diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery. Blunt trauma knowledge for medical students and physicians. Pediatric blunt abdominal trauma stephen wegner, mda,t, james e. Family physicians need to be able to recognize and treat hemorrhagic shock. Accurate assessment requires an understanding of patterns of injury and the response of the child. Antoine, detroit, michigan 48226 radiology of blunt abdominal trauma raymond s. Organs such as your pancreas, liver, spleen, or bladder may be injured. Focused abdominal sonography for trauma in the clinical. Professor of radiology, wayne state university school of medicine, detroit, michigan professor of radiology, wayne state university school of medicine detroit michigan the condition of the patient and the clinical findings take. Abdominal trauma is usually divided into blunt and penetrating trauma findings of abdominal trauma.
The majority of bat cases 75 percent are related to motor vehicle collision mvc or auto versus pedestrian accidents 2. The mechanism of trauma is quite similar to that of the adults, but. Request pdf pediatric blunt abdominal trauma blunt pediatric trauma is a major threat to the health and wellbeing of children. In the united states, trauma is a serious health problem, both as a cause of mortality and as a significant financial burden. Pediatric abdominal trauma is typically blunt in nature with the spleen being the most common organ injured. Cheryl pirozzi, md fellows conference 5411 abdominal trauma penetrating abdominal trauma stabbing 3x more common than firearm wounds gsw cause 90% of the deaths most commonly injured organs. The pressure within the abdominal cavity, or intraabdominal pressure in a normal person is 05 mmhg. Laboratory testing contributes significantly to the identification of children with intra abdominal injuries after blunt trauma. Blunt trauma is most commonly due to motor vehicle accidents and is a major cause of morbidity and mortality in all age groups.
Abdominal ct or ultrasound fast laboratory testing to screen for intra abdominal injury chest or pelvic radiography figure 1. The role of abdominal ct in the evaluation of stab wounds to the back. Colon injury occurs in 2% to 15% of patients having blunt abdominal trauma. Such management is a safer, successful, and more costeffective way to care for these patients and. Significant variability in the initial trauma assessment exists among institutions. Pediatric blunt abdominal trauma request pdf researchgate. The trauma registry of a single level i pediatric trauma center was queried for the results of fast examination of consecutive pediatric pdf. Blunt abdominal trauma in pediatrics 201101 ahc media. Blunt abdominal trauma in children trauma is the leading cause of death in pediatric patients older than one year, with abdominal trauma accounting for 10% of the causes of death1. For patient education resources, see the wounds center, the trauma resource center, and the childrens health center, as well as puncture wound and bruises. Abdominal ct or ultrasound fast laboratory testing to screen for intraabdominal injury chest or pelvic radiography figure 1. All patients with abdominal trauma or suspected abdominal trauma. The objective of this study was to assess the sensitivity and specificity of fast for detecting free peritoneal fluid in children. Gastrointestinal injuries from blunt abdominal trauma in children.
Blunt abdominal trauma american academy of pediatrics. The finding of more than trace amounts of free fluid in the absence of solid organ injury in bat is often associated with clinically significant visceral. Greater incidence of abdominal, chest and spinal cord injury without fracture high surface areabody volume greater. Diagnosis may involve ultrasonography, computed tomography, and peritoneal lavage, and treatment may involve surgery. The difference in severity between presenting symptoms and actual injuries in a significant number. No abdominal tenderness, abdominal pain, or vomiting. It is divided into two types blunt or penetrating and may involve damage to. Abdominal injuries are found in 2030% of patients with multiorgan injuries. These injuries are caused by car accidents, sports injuries, or a fall.
Intra abdominal free fluid without solid organ injury in blunt abdominal trauma. Identifying children at very low risk of clinically. Victims frequently have both abdominal and extraabdominalinjuries. Various factors, including blunt trauma can lead to increased abdominal pressure or intra abdominal hypertension which is defined as sustained pressures over 12 mmhg lee, 2012. In pediatric care, the role of focused abdominal sonography in trauma fast remains ill defined. Common abdominal organ injuries involve the liver, spleen, kidneys, intestines and vasculature. Abdominal trauma is responsible for about 10% of all deaths related to trama. Pdf genitourinary injuries in pediatric blunt trauma. Blunt abdominal trauma bat accounts for the majority 80 percent of abdominal injuries seen in the emergency department, and is responsible for substantial morbidity and mortality. The nature and severity of abdominal injuries vary widely depending on the mechanism and forces involved, thus generalizations about mortality and need for operative repair tend to be misleading.
Department of radiology, detroit memorial hospital, 1420 st. No evidence of abdominal wall trauma or seat belt sign. During a 4 year period, 372 patients were admitted for blunt abdominal trauma, of which 47 patients underwent laparotomy. Blunt abdominal injury bai is common and usually results from motor vehicle collisions mvc, falls and assaults. Imaging of blunt abdominal trauma university of ottawa. Pediatric abdominal trauma is common, with delays in diagnosis and. The close proximity of organs within the torso makes distinguishing. Examination and evaluation 1 visually note wounds and abrasions 2palpate abdomen for localized and diffuse tenderness 3consider possible internal injuries eg. Unknown history, distracting injuries, and altered mental status make these patients difficult to diagnose and manage.
Clinical examination alone is inadequate because patients may have altered mental status and distracting injuries. Jan 23, 2011 table diagnostic modalities in abdominal trauma cont gruessner b, mentges b, duber c, et al. Trauma is a leading cause of morbidity and mortality in childhood, and blunt trauma accounts for 8090 % of abdominal injuries. Jun 18, 2014 abdominal injuries require surgery in about 25% of cases. Trauma is the leading cause of death in pediatric patients older than one year, with abdominal trauma accounting for 10% of. Apr 26, 2008 the investigation of blunt abdominal trauma is a challenging and contentious subject with a limited evidence base. Penetrating neck trauma 4344 blunt aortic injury 4546 blunt cardiac injury 4748 penetrating chest trauma to the box 4950 ed thoracotomy edt 5152 hemothorax 5354 truncal stab wounds back, flank, abdomen 5556 blunt abdominal trauma 5758 blunt splenic trauma 5960 blunt bowel and mesenteric injury 6162 rectal injury 6364 pelvic. Blunt abdominal trauma can occur through several mechanisms, which include direct blows or sudden rapid compression of the patients abdomen. Evaluation of a patient with blunt abdominal trauma. Table diagnostic modalities in abdominal trauma cont gruessner b, mentges b, duber c, et al. Abdominal trauma, especially those caused by blunt force is a leading cause of morbidity and mortality in all age groups, but it is one of the most challenging conditions emergency department physicians encounter because of varied presentations. The close proximity of organs within the torso makes distinguishing between abdomen, chest and pelvic injuries difficult.
A blunt abdominal injury is a direct blow to the abdomen without an open wound. To identify predictors of abdominal injuries in victims of blunt trauma. The spleen is the organ damaged most commonly, followed by the liver and a hollow viscus typically the small intesti. Stony brook university medical center stony brook, ny. The patterns of chest injury are highly dependent on the intensity of the trauma and. Many serious abdominal injuries may appear insignificant, making it extremely difficult to predict severity. The algorithm proposed here is widely accepted and should help doctors in emergency departments decide on the most appropriate form of investigation pending the arrival of a specialist.
Good morning music vr 360 positive vibrations 528hz the deepest healing boost your vibration duration. Common causes of abdominal injury include blunt trauma motor vehicle accidents mvas and falls, and penetrating trauma gunshot wounds gsws and stabbings. No thoracic wall trauma or decreased breath sounds. Abdominal injuries require surgery in about 25% of cases. Variables were compared between patients with abdominal injuries detected by computed tomography orand laparotomy abbreviated injury scale abdome0 group i and. Repetitive examinations in a comforting environment will yield superior clinical judgment. Surgeons, emergency medicine, pediatricians learning objectives. 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.
Abdominal pain distension discoloration of abdomen unexplained shock 11. The most common causes of serious blunt abdominal trauma in the united states are motor vehicle accidents and falls. Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation. Signs and symptoms include abdominal pain, tenderness, rigidity, and bruising of the external abdomen. Pediatric blunt abdominal trauma peacehealth novel coronavirus covid19 information for patients, visitors and medical professionals. 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. The algorithm proposed here is widely accepted and should help doctors in emergency departments decide on the most appropriate form of investigation pending the arrival of. The pressure within the abdominal cavity, or intra abdominal pressure in a normal person is 05 mmhg.
Blunt abdominal trauma the most common causes of serious blunt abdominal trauma in the united states are motor vehicle accidents and falls. Imagenes pediatricas gastrointestinal injuries from blunt. Describe common mechanisms for pediatric trauma and injury patterns. Such management is a safer, successful, and more cost. Various factors, including blunt trauma can lead to increased abdominal pressure or intraabdominal hypertension which is defined as sustained pressures over 12 mmhg lee, 2012. Complications may include blood loss and infection. The patterns of chest injury are highly dependent on the intensity of the trauma and may vary from harmless contusions to possible. Oct 17, 2019 for more information, see abdominal vascular injuries, penetrating abdominal trauma, blunt abdominal trauma and focused assessment with sonography in trauma fast. Penetrating and blunt trauma to the abdomen can produce significant and lifethreatening injuries. Marwan a, harmon cm, georgeson ke, smith gf, muensterer oj. Paul, mn 551012502, usa cdivision of emergency medicine, department of surgery, department of pediatrics. The investigation of blunt abdominal trauma is a challenging and contentious subject with a limited evidence base. Significant intraabdominal injury after blunt torso trauma highly unlikely 0.
Oct 17, 2019 marwan a, harmon cm, georgeson ke, smith gf, muensterer oj. Blunt abdominal trauma evaluation and management guideline. The proposed project is a prospective, observational, multiinstitutional study of children following blunt abdominal trauma. Regardless of restraint usage, associated injuries are. Diagnostic imaging of blunt abdominal trauma in pediatric. Abdominal trauma ppt major trauma medical specialties.
Abdominal trauma may involve penetrating or blunt injuries. The assessment and treatment of children with specific injuries to. The abdomen can be injured in many types of trauma. Abdominal trauma remains a leading cause of mortality in all age groups.
Penetrating injuries often result in injury to hollow organs, such as the intestines. Blunt trauma may involve a direct blow eg, kick, impact with an object eg, fall on bicycle handlebars, or sudden deceleration eg, fall from a height, vehicle crash. Pdf blunt abdominal trauma in children researchgate. Physician concern for abdominal trauma resulting in any of the following diagnostic or screening tests.
For more information, see abdominal vascular injuries, penetrating abdominal trauma, blunt abdominal trauma and focused assessment with sonography in trauma fast. This figure is consistent with the 515% reported in other series, making the intestine the third most commonly injured organ in blunt trauma. Blunt and penetrating abdominal trauma are major causes of morbidity and mortality in the united states, particularly because it can be very difficult to recognize clear symptoms early. Traumatic lacerations to the right and left liver lobes arrows, image 1a and pancreas image 1b, arrow with left renal pedicle injury lack of enhancement of the left kidney, arrow, 1b image 1b 2a blunt abdominal trauma. Identify stateoftheart treatment modalities and management for various injuries. The majority occurs in motor vehicle accidents, in which rapid deceleration may propel the driver into the steering wheel, dashboard, or seatbelt causing contusions in less serious cases, or rupture of internal organs from briefly increased intraluminal pressure in the more serious. Most of these injuries are due to motor vehicle collisions 74%, and the incorrect placement of safety belts has been implicated as an additional risk factor. Sonography versus peritoneal lavage in blunt abdominal trauma. Blunt abdominal trauma in childhood is a common clinical occurrence. The signs and symptoms may include abdominal pain, tenderness, rigidity. Pediatric blunt abdominal trauma clinical prediction model. Use of laparoscopy in the management of pediatric abdominal trauma. Identifying children at very low risk of clinically important.
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