Considerations and Evaluations on Abdominal Trauma in Pediatric Age.

Dogjani, Agron; Haxhirexha, Kastriot; Selmani, Edvin; Bendo, Hysni; Blloshmi, Amarildo; Craga, Briselda · 2019 · Crossref

DOI: 10.32391/ajtes.v3i2.64

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Summary

This retrospective study investigates the epidemiology, mechanisms, and clinical outcomes of blunt abdominal trauma (BAT) in pediatric patients. Motivated by the fact that trauma is a leading cause of morbidity and mortality in children, the research aims to characterize BAT patterns, evaluate the relationship between injury severity and treatment strategies, and assess the utility of trauma scoring systems in predicting outcomes. The study was conducted at the University Hospital of Trauma in Tirana, Albania, reviewing data from patients presenting to the Emergency Department between December 2017 and June 2018. The study analyzed 49 pediatric patients (aged 0–16 years) who met the inclusion criteria for BAT, excluding those with severe traumatic brain injury or no intra-abdominal injuries. Data collection utilized standardized trauma scores, including the Injury Severity Score (ISS), Revised Trauma Score (RTS), and Trauma and Injury Severity Score (TRISS), alongside clinical assessments such as the Allgower formula for hemodynamic status. Statistical analysis employed Kendall’s tau-b correlation coefficient and regression analysis to examine associations between variables such as mechanism of injury, mode of transport, time to presentation, and treatment outcomes. Motor vehicle accidents were the most frequent cause of injury (55%), followed by falls from height (33%). Abdominal trauma accounted for 13.7% of total pediatric trauma cases in the cohort. The study found a statistically significant correlation between higher ISS scores and increased complication rates ($r = 0.254, p < 0.001$) as well as longer hospital stays ($r = 0.279, p < 0.001$). Treatment strategies were nearly evenly split between operative management (52%) and non-operative management (48%). Operative intervention was strongly associated with higher ISS scores ($r = 0.318, p < 0.001$), particularly when ISS exceeded 25. The spleen was the most commonly injured organ, followed by the liver. Mortality was observed in 8% of the cohort, primarily due to acute irreversible shock or traumatic brain injury. The authors conclude that BAT poses a serious threat to pediatric health and requires rigorous management protocols in both tertiary and regional hospitals. The study highlights the predictive value of trauma scores like ISS and TRISS in determining injury gravity and guiding treatment decisions. While non-operative management is increasingly favored in literature, this cohort showed a high rate of operative intervention, often necessitated by hemodynamic instability or polytrauma. The findings underscore the importance of early assessment, appropriate transport modes, and the integration of standardized scoring systems to improve trauma care outcomes in children.

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• incidence prevalence