Management of pediatric blunt abdominal trauma in resource-restricted settings: a cross-sectional study
Iranian Journal of Pediatric Surgery,
Vol. 2 No. 1 (2016),
23 August 2016
Introduction: Management of pediatric blunt abdominal trauma in resource-restricted settings requires precise clinical expertise. In this study, we reviewed pediatric patients who were suspected to have blunt abdominal trauma in a level III trauma center in Iran.
Materials and Methods: In a cross-sectional study, 66 injured children were studied from October 01, 2014 to October 01, 2015 in Nikshahr, Sistan-va-Balouchestan, Iran. Patient characteristics, type of trauma, initial evaluation and final decisions were analyzed.
Results: Mean age was 8.2 ± 13.3 years. Thirty five patients (53%) were boys and 31 patients (47%) were girls. Focused Assessment with Sonography for Trauma (FAST) was done for all patients. Diagnostic Peritoneal Lavage (DPL) was done on five patients (7.6%). Laparatomy was conducted on seven patients (10.6%). Ten patients (15.2%) were referred to a higher level trauma center. There were three mortalities (4.5%). Positive FAST was associated with hemodynamic instability (p<0.05) and the need for laparatomy (p<0.05). Positive FAST was also associated with more admission days (5.9 ± 5.1 days versus 2.1 ± 2.6 days; p<0.05). There was also a significant relationship between the length of hospital stay and associated traumas (p<0.001).
Conclusion: Computed tomography and intensive care unit may be unavailable in resource restricted settings with level III and IV trauma centers. However, physical examination, FAST and DPL are useful diagnostic tools for assessment of injured children with blunt abdominal trauma.
- abdominal trauma
- blunt trauma
- pediatric trauma
How to Cite
Hackam DJ, Grikscheit T, Wang K, et al: Pediatric Surgery, In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE (eds). Schwartz’s Principles of Surgery. McGraw Hill, NY, 2015, pp. 1642-4.
Burlew CC, Moore EE: Trauma, In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE (eds). Schwartz’s Principles of Surgery. McGraw Hill, NY, 2015, pp. 222-3.
Notrica DM: Pediatric blunt abdominal trauma: current management. Curr Opin Crit Care. 2015;21(6):531-7.
Zarrintan S, Aslanabadi S, Rikhtegar R:Impact of the Iranian 2012 earthquake on pediatric surgery: an urgent need to establish pediatric trauma centers in Iran. J Pediatr Surg. 2013;48(2):474.
Safavi A, Skarsgard ED, Rhee P, et al: Trauma center variation in the management of pediatric patients with blunt abdominal solid organ injury: a national trauma data bank analysis. J Pediatr Surg. 2016;51(3):499-502.
deVries CR, Price RR:Global Surgery and Public Health: A New Paradigm. Jones & Barrlett Learning, LLC, UK, 2012, pp. 237-68.
Trauma Center Levels Explained. American Trauma Society (ATS). Accessed online at http://www.amtrauma. org/?page=traumalevels, on April 18, 2016
Stylianos S, Pearl RH: Abdominal Trauma, In: Coran AG, Adzick NS, Krummel TM, Laberge J, Shamberger RC, Caldamone AA (eds). Pediatric Surgery. Saunders, Philadelphia, 2012, pp. 289-309.
Miele V, Piccolo CL, Trinci M, et al: Diagnostic imaging of blunt abdominal trauma in pediatric patients. Radiol Med. 2016, in press.
Carter KW, Moulton SL: Pediatric abdominal injury patterns caused by “falls”: A comparison between nonaccidental and accidental trauma. J Pediatr Surg. 2016;51(2):326-8.
Fahy AS, Antiel RM, Polites SF, et al: Pretransfer computed tomography delays arrival to definitive care without affecting pediatric trauma outcomes. J Pediatr Surg. 2016 Feb;51(2):323-5.
Leschied JR, Mazza MB, Davenport MS, Chong ST, Smith EA, Hoff CN, Ladino-Torres MF, Khalatbari S, Ehrlich PF, Dillman JR. Inter-radiologist agreement for CT scoring of pediatric splenic injuries and effect on an established clinical practice guideline. Pediatr Radiol. 2015, in press.
Kakaei F, Zarrintan S, Rikhtegar R, et al: Iranian 2012 earthquake: the importance of Focused Assessment with Sonography for Trauma (FAST) in assessing a huge mass of injured people. Emerg Radiol. 2013;20(4):307-8.
Rabbani K, Narjis Y, Louzi A, et al: Place of non-operative treatment of abdominal contusions in developing countries. Pan Afr Med J. 2015 16;20:132.
Murphy EE, Murphy SG, Cipolle MD, et al: The pediatric trauma center and the inclusive trauma system: Impact on splenectomy rates. J Trauma Acute Care Surg. 2015;78(5):930-3; discussion 933-4.
Bairdain S, Litman HJ, Troy M, et al: Twenty-years of splenic preservation at a level 1 pediatric trauma center. J Pediatr Surg. 2015;50(5):864-8.
Holland AJ, McBride CA: Non-operative advances: what has happened in the last 50 years in paediatric surgery? J Paediatr Child Health. 2015;51(1):74-7.
Djordjevic I, Slavkovic A, Marjanovic Z, et al: Blunt Trauma in Paediatric Patients - Experience from a Small Centre. West Indian Med J. 2015;64(2):126-30.
- Abstract Viewed: 606 times
- PDF Downloaded: 216 times