Blunt Abdominal Trauma in Children: Mechanisms of Accident and Management

Aim of the study: We analyzed mechanisms and management in children with blunt abdominal trauma at a tertiary hospital in Southwest Germany, aiming to identify regional particularities to adapt prevention strategies.

Methods: Data from all children aged 0 – 17 seen at the University of Ulm between 2005 and 2015 for blunt abdominal trauma were collected in regards to age and gender, mechanism of injury, clinical presentation, severity of injury, radiologic imaging, treatment modality, complications and length of hospital stay, among others. All data were statistically analyzed accepting a confidence interval of 95%.

Results: 134 children were enrolled in the study. Mechanisms of accident were mostly associated with age, leading causes of trauma were falls (56%), sport-related traumas (41,8%) and road-traffic accidents (21.6%). Boys suffered more often (67,9%) an intraabdominal injury (IAI; p=0.034) with higher scores for severe injury (p=0,014) in older age (p=0.008). These children also had more often abnormal laboratory (p<0.001). Focused Assessment with Sonography for Trauma (FAST) was primarily performed in 85,8% of the patients and identified a significant correlation between free abdominal fluid and injury pattern (p<0.001), in which 41,8% had an IAI with organ laceration and 46,3% had additional injuries. Conservative treatment of IAI was performed in 60,7% and abdominal surgery in 39,2% of the patients. Complications occurred in 34.4%, significantly higher after spleen (p=0.001), liver (p=0.001) and GI injuries (p=0.001). The length of hospital stay increased with the severity of the injury (p<0.001), especially after child abuse.

Conclusions: Risks for severe IAI were present even in banal daily activities, which must be passed on to parents and children. Despite its rarity, massive IAI after child abuse was observed and should always be considered as a potential differential diagnosis. Further programs of accident prevention should focus on the most susceptible group of school-age boys.