From
StayCurrentMD
Trauma Talk Summary: Update Course 2017
With Dr. Christian Streck · hosted by Dr. Todd Ponsky
Part of
Blunt Abdominal Trauma 8 items
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Indications for CT Scan for Blunt Abdominal Trauma: Update Course 2017
34 min · Published Aug 2017
Video
Abdominal Evaluation: Pediatric Trauma Series 2017
85 min · Published Jan 2018
Podcast
Pediatric Trauma With Dr. Richard Falcone
56 min · Published May 2017
Video
Isolated low-grade solid organ injuries in children following blunt abdominal trauma
Published May 2023
Video
Guías APSA actualizadas para el tratamiento de lesiones contusas del hígado y del bazo
Published Nov 2023
Video
Laparoscopic Distal Pancreatectomy for Traumatic Transection
4 min · Published Nov 2019
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What the experts said
97% of pediatric blunt trauma patients presenting to trauma centers are hemodynamically stable
A seat belt contusion indicates tremendous force generated against the patient and requires vigilance for underlying abdominal injury
Bowel injury is difficult to assess on CT scan even when solid organ injuries can be identified
FAST ultrasound is not sensitive or specific enough for pediatric abdominal trauma evaluation
IV contrast for ultrasound may improve FAST utility in the future but is not currently helpful
Patients evaluated only by the emergency department (lowest tier activations) receive more labs and sometimes more imaging than higher-tier activations
A seat belt sign over the anterior superior iliac spine (correct position) may represent only soft tissue injury and can be observed, whereas a seat belt sign in the wrong position (higher on abdomen) is more concerning
The seat belt should be positioned over the bony pelvis; this is why booster seats are used in children
Less than 12% of pediatric patients scanned for blunt abdominal trauma have an intra-abdominal injury
Fewer than 3% of pediatric blunt trauma patients with severe mechanisms have an injury requiring acute intervention
90% of pediatric trauma patients present to non-pediatric centers where pan-CT is standard practice
CT scan ordering rates for pediatric blunt abdominal trauma varied from 4% to 96% across 14 participating trauma centers
The 2012 PECARN prediction model using only history and physical exam was very sensitive for injuries requiring acute intervention but missed many clinically relevant solid organ injuries
Five variables predict intra-abdominal injury: AST >200, abnormal abdominal physical exam, abnormal chest X-ray, abdominal pain, and elevated amylase or lipase
When all five prediction variables are negative, the risk of intra-abdominal injury is 0.6% and risk of injury requiring acute intervention is 0%
The five-variable model identifies 34% of pediatric blunt trauma patients who can safely avoid abdominal CT
The negative predictive value of the five-variable model was 100% for injury requiring intervention and 99.4% for all injuries
A modified low-risk group (55% of patients) with fewer than all five variables positive has less than 5% risk of any injury and less than 0.3% risk of injury requiring acute intervention
Clinicians can wait up to one hour for laboratory results (AST, lipase) before deciding on abdominal CT in stable patients with reliable exams
Oral contrast does not add diagnostic value for identifying small bowel or colonic injuries in pediatric blunt trauma
Modern multi-slice CT scanners typically show subtle findings (even without free air) that raise concern for hollow viscus injury
Serial abdominal examinations over 6-12 hours can help determine need for operative intervention even when CT findings are equivocal
Bowel injury, although significant, is not immediately life-threatening and can be safely observed for several hours before definitive management
Laparoscopy is extremely helpful in 2017 for patients with moderate free fluid and no hard signs of small bowel perforation
It is very rare to miss an injury during laparoscopic exploration of pediatric abdominal trauma
Either amylase or lipase is acceptable for pancreatic injury screening; institutions vary in which enzyme they use
The five-variable prediction model has been validated in the publicly available PECARN dataset with significant negative predictive value
The CHOP study established that if either AST or ALT is over 200, abdominal CT should be obtained
Adult trauma literature suggests pan-CT is safer, has fewer missed injuries, and is more cost-effective
An APSA study supports that missed bowel injury diagnosed within 24 hours does not increase morbidity
There is huge variability across institutions in laboratory evaluation practices for pediatric blunt abdominal trauma