Clinical Pediatric Emergency Medicine
Volume 6, Issue 1 , Pages 23-31 , March 2005

Blunt Abdominal Trauma in the Pediatric Patient

  • Douglas A. Potoka, MD

      Affiliations

    • Department of Pediatric Surgery, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, PA
    • Corresponding Author InformationReprint requests and correspondence: Douglas A. Potoka, MD, Department of Pediatric Surgery, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, PA 15213.
  • ,
  • Richard A. Saladino, MD

      Affiliations

    • Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh, PA

References 

  1. Schafermeyer R. Pediatric trauma. Emerg Med Clin North Am. 1993;11:187–205
  2. Centers for Disease Control. National Center for Injury Prevention and Control . http://www.cdc.gov/ncipc/osp/charts.htm[Accessed August 2004]
  3. Arkovitz MS, Johnson N, Garcia VF. Pancreatic trauma in children: mechanisms of injury. J Trauma. 1997;42:49–53
  4. Clarnette TD, Beasley SW. Handlebar injuries in children: patterns and prevention. Aust NZ J Surg. 1997;67:338
  5. Newman KD, Bowman LM, Eichelberger MR, et al. The lap belt complex: intestinal and lumbar spine injuries and seatbelt use. J Trauma. 1990;30:1133–1138
  6. Committee on Trauma. Advanced Trauma Life Support. 6th ed.. Chicago (Ill): American College of Surgeons; 1997;
  7. Potoka DA, Schall LC, Gardner MJ, et al. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma. 2000;49:237–245
  8. Cotton BA, Beckert BW, Smith MK, et al. The utility of clinical and laboratory data for predicting intraabdominal injury among children. J Trauma. 2004;56:1068–1075
  9. Holmes JF, Sokolove PE, Land C, et al. Identification of intra-abdominal injuries in children hospitalized following blunt torso trauma. Acad Emerg Med. 1999;6:799–806
  10. Hennes HM, Smith DS, Schneider K, et al. Elevated liver transaminase levels in children with blunt abdominal trauma: a predictor of liver injury. Pediatrics. 1990;86:87–90
  11. Puranik SR, Hayes JS, Long J, et al. Liver enzymes as predictors of liver damage due to blunt abdominal trauma in children. South Med J. 2002;95:203–206
  12. Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg. 1990;125:1109–1113
  13. Karaduman D, Sarioglu-Buke A, Kilic I, et al. The role of elevated liver transaminase levels in children with blunt abdominal trauma. Injury. 2003;34:249–252
  14. Jones RC. Management of pancreatic trauma. Am J Surg. 1985;150:698–704
  15. Moretz JA, Campbell DP, Parker DE, et al. Significance of serum amylase level in evaluating pancreatic trauma. Am J Surg. 1975;130:739–741
  16. Takishima T, Sugimoto K, Hirata M, et al. Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations. Ann Surg. 1997;226:70–76
  17. Vitale GC, Larson GM, Davidson PR, et al. Analysis of hyperamylasemia in patients with severe head injury. J Surg Res. 1987;43:226–233
  18. Bradley EL, Young PR, Chang MC, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg. 1998;227:861–869
  19. Nadler EP, Gardner M, Schall LC, et al. Management of blunt pancreatic injury in children. J Trauma. 1999;47:1098–1103
  20. Beaver BL, Colombani PM, Fal A, et al. The efficacy of computed tomography in evaluating abdominal injuries in children with major head trauma. J Pediatr Surg. 1987;22:1117–1122
  21. Haftel AJ, Lev R, Mahour GH, et al. Abdominal CT scanning in pediatric blunt trauma. Ann Emerg Med. 1988;17:684–689
  22. Kane NM, Cronan JJ, Dorfman GS, et al. Pediatric abdominal trauma: evaluation by computed tomography. Pediatrics. 1988;82:11–15
  23. Taylor GA, Fallat ME, Potter BM, et al. The role of computed tomography in blunt abdominal trauma in children. J Trauma. 1988;28:1660–1664
  24. Nastanski F, Cohen A, Lush SP, et al. The role of oral contrast administration immediately prior to computed tomographic evaluation of the blunt trauma victim. Injury. 2001;32:545–549
  25. Sherek JP, Oakes DD. Intestinal injuries missed by computed tomography. J Trauma. 1990;30:1–5
  26. Shankar KR, Lloyd DA, Kitteringham L, Carty HM. Oral contrast with computed tomography in the evaluation of blunt abdominal trauma in children. Br J Surg. 1999;86:1073–1077
  27. Yoshii H, Sato M, Yamamoto S, et al. Usefulness and limitations of ultrasonography in the initial evaluation of blunt abdominal trauma. J Trauma. 1998;45:45–51
  28. McKenney MG, Martin L, Lentz K, et al. 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma. 1996;40:607–612
  29. Rozycki GS, Ochsner MG, Schmidt JA, et al. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma. 1995;39:492–500
  30. Fernandez L, McKenney MG, McKenney KL, et al. Ultrasound in blunt abdominal trauma. J Trauma. 1998;45:841–848
  31. Soudack M, Epelman M, Maor R, et al. Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients. J Clin Ultrasound. 2004;32:53–61
  32. Richards JR, Knopf NA, Wang L, et al. Blunt abdominal trauma in children: evaluation with emergency US. Radiology. 2002;222:749–754
  33. Benya EC, Lim-Dunham JE, Landrum O, et al. Abdominal sonography in examination of children with blunt abdominal trauma. Am J Radiol. 2000;174:1613–1616
  34. Holmes JF, Brant WE, Bond WF, et al. Emergency department ultrasonography in the evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Surg. 2001;36:968–973
  35. Sirlin CB, Brown MA, Andrade-Barreto OA, et al. Blunt abdominal trauma: clinical value of negative screening US scans. Radiology. 2004;230:661–668
  36. Stassen NA, Lukan JK, Carrillo EH, et al. Abdominal seat belt marks in the era of focused abdominal sonography for trauma. Arch Surg. 2002;137:718–723
  37. Vane DW. Imaging of the injured child: important questions answered quickly and correctly. Surg Clin North Am. 2002;82:315–323
  38. Villavicencio RT, Aucar JA. Analysis of laparoscopy in trauma. J Am Coll Surg. 1999;189:11–20
  39. Wilson RH, Moorehead RJ. Management of splenic trauma. Injury. 1992;23:5–9
  40. Nwomeh BC, Nadler EP, Meza MP, et al. Contrast extravasation predicts the need for operative intervention in children with blunt splenic trauma. J Trauma. 2004;56:537–541
  41. Bisharat N, Omari H, Lavi I, et al. Risk of infection and death among post-splenectomy patients. J Infect. 2001;43:182–186
  42. Konstantakos AK, Baronski AL, Plaisier BR, et al. Optimizing the management of blunt splenic injury in adults and children. Surgery. 1999;126:805–812
  43. Bond SJ, Eichelberger MR, Gotschall CS, et al. Nonoperative management of blunt hepatic and splenic injury in children. Ann Surg. 1996;223:286–289
  44. Pearl RH, Wesson DE, Spence LJ, et al. Splenic injury: a 5-year update with improved results and changing criteria for conservative management. J Pediatr Surg. 1989;24:428–431
  45. Powell M, Courcoulas A, Gaedner M, et al. Management of blunt splenic trauma: significant differences between adults and children. Surgery. 1997;122:654–660
  46. Velanovich V, Tapper D. Decision analysis in children with blunt splenic trauma: the effects of observation, splenorrhaphy, or splenectomy on quality-adjusted life expectancy. J Pediatr Surg. 1993;28:179–185
  47. Stylianos S. Evidence-based guidelines for resource utilization in children with isolated spleen or liver injury: the APSA Trauma Committee. J Pediatr Surg. 2000;35:164–167
  48. Stylianos S. Compliance with evidence-based guidelines in children with isolated spleen or liver injury: a prospective study. J Pediatr Surg. 2002;37:453–456
  49. Morse MA, Garcia VF. Selective nonoperative management of pediatric blunt splenic trauma: risk for missed associated injuries. J Pediatr Surg. 1994;29:23–27
  50. Patrick DA, Bensard DD, Moore EE, et al. Nonoperative management of solid organ injuries in children results in decreased blood utilization. J Pediatr Surg. 1999;34:1695–1699
  51. Schwartz MZ, Kangah R. Splenic injury in children after blunt trauma: blood transfusion requirements and length of hospitalization for laparotomy versus observation. J Pediatr Surg. 1994;29:596–598
  52. Rovin JD, et al. Follow-up abdominal computed tomography after splenic trauma in children may not be necessary. Am Surg. 2001;67:127–130
  53. Lynch JM, et al. Computed tomography grade of splenic injury is predictive of the time required for radiographic healing. J Pediatr Surg. 1997;32:1093–1095
  54. Moss RL, Musemeche CA. Clinical judgement is superior to diagnostic tests in the management of pediatric small bowel injury. J Pediatr Surg. 1996;31:1178–1181
  55. Ford EG, Senac MO. Clinical presentation and radiographic identification of small bowel rupture following blunt trauma in children. Pediatr Emerg Care. 1993;9:139–142
  56. Jurkovich GJ, Carrico CJ. Pancreatic trauma. Surg Clin North Am. 1990;70:575–593
  57. Vane DW, Grosfeld JL, West KW, et al. Pancreatic disorders in infancy and childhood: experience with 92 cases. J Pediatr Surg. 1989;24:771–776
  58. Lerner A, Branski D, Lebenthal E. Pancreatic diseases in children. Pediatr Clin North Am. 1996;43:125–156
  59. Takishima T, et al. Characteristics of pancreatic injury in children: a comparison with such injury in adults. J Pediatr Surg. 1996;31:896–900
  60. Jobst MA, Canty TG, Lynch FP. Management of pancreatic injury in pediatric blunt abdominal trauma. J Pediatr Surg. 1999;34:818–823
  61. Horst HM, Bivins BA. Pancreatic transection. A concept of evolving injury. Arch Surg. 1989;124:1093–1095
  62. Akhrass R, Kim K, Brandt C. Computed tomography: an unreliable indicator of pancreatic trauma. Am Surg. 1996;62:647–651
  63. Akhrass R, Yaffe MB, Brandt CP, et al. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg. 1997;63:598–604
  64. Ilahi O, Bochicchio GV, Scalea TM. Efficacy of computed tomography in the diagnosis of pancreatic injury in adult blunt trauma patients: a single-institutional study. Am Surg. 2002;68:704–707
  65. Jeffrey RB, Federle MP, Crass RA. Computed tomography of pancreatic trauma. Radiology. 1983;147:491–494
  66. Kim HS, Lee DK, Kim IW, et al. The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc. 2001;54:49–55
  67. Holland AJ, Davey RB, Sparnon AL, et al. Traumatic pancreatitis: long-term review of initial non-operative management in children. J Paediatr Child Health. 1999;35:78–81
  68. Keller MS, Stafford PW, Vane DW. Conservative management of pancreatic trauma in children. J Trauma. 1997;42:1097–1100

PII: S1522-8401(05)00050-9

doi: 10.1016/j.cpem.2005.03.003

Clinical Pediatric Emergency Medicine
Volume 6, Issue 1 , Pages 23-31 , March 2005