Clinical recognition and management of pediatric blunt abdominal trauma without ultrasound or computed tomography scan in community hospitals in Mexico.
OBJECTIVE
The aim of this study was to characterize the evaluation and clinical course of children with blunt abdominal trauma in second-level hospitals.


METHODS
The authors reviewed the medical records of children, age 1 to 17 years, admitted with blunt abdominal trauma between the years 1988 to 1998. The initial evaluation included a Pediatric Trauma Score (PTS) ABCD clinical assessment, resuscitation, diagnostic peritoneal lavage (DPL), Glasgow Coma Scale (GCS), x-ray, and laboratory values. Surgical indications included active bleeding, perforated hollow viscus, or traumatic diaphragmatic hernia. Sixty-four children with blunt abdominal trauma were divided into 4 major groups: group I, obtunded children who required abdominal surgery; group II, obtunded children that did not require abdominal surgery; group III, responsive children that required abdominal surgery; group IV, responsive children that did not require abdominal surgery.


RESULTS
Analyses of each group determined that the PTS, the GCS, and ABCD assessments accurately reflected the degree of injury and outcome. Jointly with DPL they may obviate the need of ultrasound and CT scan in hospitals of second level that do not have access to these resources.


CONCLUSIONS
Recognition of blunt abdominal trauma in children may be complicated by associated multisystem injury. Systematic evaluation minimizes missed diagnosis and facilitates rapid and effective treatment. The benefit of data acquired from a good ABCD assessment, PTS, GCS, clinical and radiological, and DPL evaluation, facilitates the decision to conduct a rapid laparotomy, and they help to predict the outcome of this kind of patient.
Porras-Ramírez
G
G
Unidad de Cirugia, Unidad Hospitalaria La Paz, Hospital Regional Militar de Puebla, Mexico.
Ramírez-Reyes
F
F
Hernández-Herrera
M H
MH
Porras-Hernández
J D
JD
D000007:Abdominal Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006764:Hospitals, Community; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D008297:Male; D008800:Mexico; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*