Pediatric Blunt Abdominal Trauma Stephen Wegner, MD James E.Colletti, MD Donald Van Wie, MD

1. Pediatric Blunt Abdominal TraumaStephen Wegner, MDJames E.Colletti, MDDonald Van Wie, MD Intern 林士森

2. Preface • Abdominal trauma is a leading cause of morbidity and mortality in children. • Discussing issues： • Key issues to help for efficiently and successfully evaluate and manage blunt pediatric abdominal trauma. • Select organ trauma • Disposition issues

3. Mechanisms of injury • Motor vehicle collisions and automobile versus pedestrian accidents and falls are associated with the greatest increased risk. • Children only wearing a lap belt restrains, automobile versus bicycle accidents, all-terrain vehicle accidents, handlebar injuries, sports or nonaccidental trauma. • Abdomen-to-handlebar collisions are associated with a high risk of small bowel and pancreatic trauma.

4. Past medical history • Medical conditions that affect children’s neurologic or developmental baseline are important. • Autism, cerebral palsy, or other medical conditions that result in mental or physical handicaps. • Hemophilia • Being anticoagulated or receiving antiplatelet therapy • EB virus infection

5. Physical examination • Abnormality in abdominal PE should be considered an indicator of IAI. • Other comorbid injuries or factors predict abdominal injury. • A negative examination and absence of comorbid injuries do not totally rule out IAI.

6. Physical examination • Holmes and colleagues： • Abdominal tenderness • Cotton and colleagues： • Abdominal tenderness, ecchymosis, and abrasions as positive findings of IAI. • Isaacman： • Abnormal PE findings plus an abnormal urine analysis to be a highly sensitive screen of IAI.

7. Physical examination • Associated comorbid findings/injuries： • Femoral fracture (Holmes) • Low SBP (Holmes) • Decreased mental status • GCS<13：mild indicator of IAI (Holmes) • GCS<10：23% had significant IAI (Beaver)

8. Laboratory findings • The most valuable lab tast include the CBC, liver function tests，and urine analysis. • Amylase, lipase, coagulation studies, genaral chemistries.

9. Laboratory findings

10. Select organ trauma • Spleen and liver are the most commonly injured organ. • Hepatic trauma • Abdominal CT (enhanced) is accurate in localizing the site and extent of liver injuries and providng vital information. • Subcapsular, intrahepatic hematoma, contusion, cascular injury, biliary disruption. • American association for the surgery of trauma liver injury scale

11. Select organ trauma

12. Select organ trauma • Splenic trauma • LUQ abdominal tenderness, l’t lower rib fracture, or evidence of l’t lower chest/abdominal contusion. • managed with bed rest, frequent examination, serial Hb monitoring. • Massive disruption and hemodynamic unstability – absolute surgical indication. • Splenic rupture and EB virus infection.

13. Select organ trauma

14. Select organ trauma • Intestinal trauma • Peforation, intestinal hematoma, and mesenteric tears with bleeding. • Seatbelt sign • CT with subtle signs such as bowel wall edema. • Abdominal pain that worsens or persists and persistent emesis must be investigated with serial examinations.

15. Select organ trauma • Pancreatic trauma • Falls onto handlebar result in a crush force applied to upper abdomen. • Persistent tenderness should indicate further investigation. • Overall prognosis is good. • Renal trauma • Posterior abdomen and retroperitoneum blunt trauma • Significant flank/abdominal pain and hematuria is indication for CT scan.

16. Management and disposition • Stabilizing treatment with ATLS and PALS. • Immediate fluid resuscitation • CBC,LFTs,UA • Transfusion • Surgical consultation • Hemodynamically stable • CBC,LFTs,UA • Abnormal lab finding  CT scan

17. Length of hospitalization and return to activity

18. Thanks for your attention！