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Blunt Abdominal Trauma
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
The five-variable clinical prediction model provides guidance to the 90% of providers who don't routinely see pediatric trauma patients, indicating they don't need to scan every patient before transfer Indications for CT Scan for Blunt Abdominal Trauma: Update Course 2017 · 28:40
Indications for CT Scan for Blunt Abdominal Trauma: Update Course 2017
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At the 5th Annual Stay Current Pediatric Surgery Update Course in 2017, Dr. Christian Streck discusses indications for CT scan for blunt abdominal trauma. He includes discussion on routine labs or imaging for each level of trauma versus inj
video34:38 · Sep 2018
Resection versus non-operative management for traumatic pancreatic transection is still somewhat controversial. Laparoscopic Distal Pancreatectomy for Traumatic Transection · 0:05
Laparoscopic Distal Pancreatectomy for Traumatic Transection
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video4:58 · Nov 2019
PECARN (Pediatric Emergency Care Applied Research Network) criteria for CT imaging include Glasgow Coma Scale, abdominal examination findings, seatbelt sign, and thoracic trauma — Raphael Parrado, Trauma Abdominal Cerrado con el Dr. Raphael Parrado · 4:50
Trauma Abdominal Cerrado con el Dr. Raphael Parrado
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¿Te pasa que tienes que repasar algo sobre una patología pero necesitas que sea rapido?
En esta serie de podcast en resumen te traemos la solución ya que repasamos los temas mas comunes de la cirugía pediátrica con expertos del tema
podcast18:34 · Sep 2023
Expert statements from the recordings in this collection.
Indications for CT Scan for Blunt Abdominal Trauma: Update Course 2017
97% of pediatric blunt trauma patients presenting to trauma centers are hemodynamically stable
Seatbelt contusion indicates tremendous force and should be a red flag for underlying abdominal injury, particularly bowel injury which is difficult to assess on CT
FAST ultrasound is not sensitive or specific for pediatric abdominal trauma and will not be useful until IV contrast for ultrasound becomes available
Expert opinion4:16
AST or ALT over 200 is used as a threshold for CT scanning in blunt abdominal trauma
Seatbelt sign over the anterior superior iliac spine in the correct anatomic position may be observed, but seatbelt sign in the wrong location (higher on abdomen) requires more aggressive evaluation
Less than 12% of pediatric blunt trauma patients have an injury on abdominal CT
90% of pediatric trauma patients present to non-pediatric centers where pan-CT is standard practice
Adult trauma literature suggests pan-CT is safer, has fewer missed injuries, and is more cost-effective
The PECARN study (2012) used only history and physical exam findings to predict injuries requiring acute intervention, defined as urgent surgery, angiography, transfusion, or 48-hour admission for IV fluids
The PECARN model was very sensitive for injuries requiring acute intervention but missed many clinically relevant solid organ injuries
In the multi-center study, CT scan ordering rates ranged from 4% to 96% across four centers, indicating substantial opportunity for practice improvement
Five variables predict intra-abdominal injury: AST >200, abnormal abdominal physical exam, abnormal chest X-ray, complaint of abdominal pain, and elevated amylase or lipase
When all five predictor variables are negative, the risk of intra-abdominal injury is 0.6% and risk of injury requiring acute intervention is 0%
At least one-third of pediatric blunt trauma patients with severe mechanisms do not need abdominal CT based on the five-variable prediction model
The negative predictive value of the five-variable model is 100% for injury requiring intervention and 99.4% for all injuries
Risk of injury increases with the number of abnormal predictor variables present
A low-risk group (55% of population) can be identified with less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention
Waiting one hour for lab results in stable patients with reliable exams is acceptable before deciding on abdominal CT
Expert opinion18:05
Multi-slice CT scanners can identify subtle findings of small bowel or hollow viscus injury even without oral contrast
Serial abdominal exams over time can help determine need for further evaluation even when CT findings are equivocal
A missed bowel injury, if caught within 24 hours, usually causes no increased morbidity
Laparoscopy is extremely helpful for evaluating moderate free fluid in males with no hard signs of small bowel perforation
It is very rare to miss an injury during laparoscopic exploration in the current era
Expert opinion21:49
There is huge variability across institutions in which labs are ordered for trauma evaluation (amylase vs lipase vs both)
FAST ultrasound had 27.8% sensitivity for any intra-abdominal injury and 44% sensitivity for injury requiring intervention in the study cohort
FAST ultrasound detected only 9 of 42 liver injuries (approximately 1 in 4) in the study
FAST ultrasound detected 13 of 30 spleen injuries in the study
FAST may be helpful in hemodynamically unstable patients to identify hemoperitoneum and determine which body cavity is contributing to instability
Of 14 centers in the study, only one used negative FAST to reduce CT rates, and two centers actually performed more CTs after FAST
FAST is not being used effectively to determine which patients can avoid CT
Expert opinion26:50