Publication Date: January 2020 (Volume 17, Supplement 1)
CME Credits: 4 AMA PRA Category 1 Credits™. CME expires 01/15/2023. This course is included with an Pediatric Emergency Medicine Practice subscription
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.
Blunt abdominal trauma is the third most common cause of pediatric deaths from trauma, but it is the most common unrecognized fatal injury. The history and physical examination, combined with the mechanism of injury, should be used to develop a thoughtful and directed diagnostic workup. The mainstays of diagnostic evaluation include laboratory testing, sonography, and computed tomography. However, due to the concern for radiation exposure and other risks, the routine use of these studies may not be necessary, and controversy exists as to which studies are beneficial and which are less valuable. This supplement discusses common mechanisms and injuries seen in children with blunt abdominal trauma and takes a closer look at evaluation and management techniques.
Excerpt From This Issue
Trauma remains the leading cause of childhood death and disability in children aged > 1 year.1 While head and thoracic trauma account for most death and disability in children, abdominal injuries constitute the most commonly unrecognized cause of death.2 Blunt injury accounts for 90% of abdominal trauma in children.2 Common mechanisms include motor vehicle crashes (MVCs), falls, pedestrian injuries, bicycle and sports-related injuries, and nonaccidental trauma (NAT). Penetrating injuries are much less common in children than in adults.2
Management of pediatric trauma has unique challenges. The developmental stage of the patient, a lack of verbal skills in younger patients, and a lack of prehospital information create limitations in managing the injured child.3 Similar to their adult counterparts, children can have an unreliable abdominal examination from an associated head injury and a decreased Glasgow Coma Scale (GCS) score. Additionally, children are more likely to have an unreliable abdominal examination secondary to crying and abdominal distension.2