Background
In trauma, children are at ↑ risk on intra-abdominal injury
- Size - less protection of relatively larger organs
- Abdominal wall thin, chest wall compliant (less protection)
- Increased work of breathing (chest & upper abdo trauma)
- Kidneys lower (less rib protection) and bladder intra-abdominal in infant
- Kids have less FRC and cardiac reserve (high baseline O2 consumption)
- Children x2 O2 consumption (less reserve) than adults
- Tolerate pre-load interruption (TPTX) less well than adults
- ↓BP is a very late sign
PECARN rule
- No evidence of abdominal wall trauma
- Glasgow Coma Scale score > 13
- No abdominal tenderness
- No evidence of thoracic wall trauma
- No complaints of abdominal pain
- No decreased breath sounds
- No vomiting
Following blunt abdominal trauma, children with clinically low suspicion of intra-abdominal injury and no PECARN criteria can be managed conservatively with observation and re-examination rather than immediate CT.
Links
- Holmes JF et al Pediatric Emergency Care Applied Research Network (PECARN). Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013; 62(2): 107-116. PMID: 23375510
- Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra-abdominal Injuries After Blunt Torso Trauma .Acad Emerg Med. 2015 Sep;22(9):1034-41. doi: 10.1111/acem.12739. Epub 2015 Aug 20