Paediatric abdominal trauma



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.



Content by Dr Íomhar O' Sullivan 06/12/2015 Last review Dr ÍOS 16/06/21.