DOI: http://dx.doi.org/10.18203/2349-2902.isj20184650

Epidemiology and injury pattern in blunt trauma abdomen in pediatric population: a two-year experience in a tertiary care institute of Kashmir, India

Arshid Iqbal Qadri, Younis Ahmad, Gowhar Aziz Bhat, Aamir A. Khan, Khalid Bashir

Abstract


Background: Blunt abdominal trauma is a frequent cause for presentation of children to the Emergency Department. Children are prone to sustain injuries to intra-abdominal organs after blunt abdominal trauma because of their peculiar body habitus and relatively immature musculoskeletal system. Objectives of this study is to assess the various epidemiological parameters that influences the causation of trauma as well as injury pattern in blunt trauma abdomen in pediatric population.

Methods: The present observational hospital based prospective study was carried out in 96 blunt abdominal trauma patients of both sexes aged up to 12 years, over a period of 2 years. The parameters such as age group, sex, mode of trauma, type of injury, and the overall mortality as well as mortality were assessed.

Results: The most common mode of injury was road traffic accidents (54.2%) followed by fall from height (41.70%). Splenic injury was the most common in 58.30%, followed by hepatic injuries 34.40% and renal injuries 12.50 %. The accuracy of ultrasonography (USG) was 83.33% while accuracy of computed tomography (CECT) as a diagnostic test was 93.33%. When comparing USG findings with operative findings sensitivity of USG was 88% with positive predictive value (PPV) of 91.66% while as specificity was 60% with negative predictive value (NPV) of 50%. Sensitivity of CT scan was 96.00% with PPV of 96.00% and specificity of CECT scan was 80.00% with NPV of 80.00%.

Conclusions: The majority of pediatric injuries are preventable by knowing the epidemiology and pattern of pediatric trauma.


Keywords


Blunt abdominal trauma, Computed tomography, Epidemiology ultrasonography, Pediatric

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References


Krug, EG, Sharma, GK, Lozano R. The global burden of injuries. Am J Public Health. 2000;90:523-6.

National Crime Records Bureau. Accidental deaths and suicides in India. Ministry of Home Affairs, New Delhi, Government of India. 2007.

Adesanya AA, Afolabi JR. da Rocha-Afodu JT. Civilian abdominal gunshot wounds in Lagos. J R Coll Surg Edinb. 1998;43(4):230-4.

Aldemir M, Tacyildiz I, Girgin S. Predicting factors for mortality in the penetrating abdominal trauma. Acta Chirurgica Belgica. 2004;104:429-34.

Anderson RN, Smith BL. Deaths: leading causes for 2001. Natl Vital Stat Rep. 2003;52(9):1-85.

Gaines BA, Ford HR. Abdominal and pelvic trauma in children. Crit Care Med. 2002;30(11):S416-23.

Ma WJ, Xu HF, Chao JX. Analysis on pedestrian traffic injury among aged 0-14 year’s children in Guangzhou, China. Zhonghua Liu Xing Bing Xue Za Zhi. 2007;28(6):576-9.

Cooper A, Barlow B, Discala C. Mortality and truncal injury: the pediatric perspective. J Pediatr Surg. 1994;29(1):33-8.

Craig A, Meza M, Mary J. Is computed tomography a useful adjunct to the clinical examination for the diagnosis of pediatric gastrointestinal perforation from blunt abdominal trauma in children? J Trauma. 1996;40(3):417-21.

Jerby B, Robert JA, Duncan M. Blunt intestinal injury in children - the role of physical examination. J Pediatr Surg. 1997;32(4):580-4.

Holmes J, William EB, William FB. Emergency department USG in evaluation of hypotensive and normotensive children with blunt abdominal trauma. J Pediatr Trauma. 2001;36(7):968-73.

Richards J, Nicolette A, John P. Blunt abdominal trauma in children- evaluation with emergency US. J Radiol. 2002;222:749-54.

Emery K, Constance M, John MR. Absent peritoneal fluid on screening trauma USG in children: a prospective comparison with CT scan. J Pediatr Surg. 2001;36(4):565-9.

Soudack M, Epelman M, Maor R. Experience with focused abdominal sonography for trauma (FAST) in 313 pediatric patients. J Clin Ultrasound. 2004;32:53-61.

Awasthi S, Mao A, Wooton SL. Is hospital admission and observation required after a normal abdominal computed tomography scan in children with blunt abdominal trauma? J Emerg Med. 2008;15(10):895-9.

Haller J, Pat P, Drugas G, Colombani P. Non-operative management of solid organ injuries in children. Ann. Surg. 1994;219(6):625-31.

Naomi K, Cronan J, Gray D. Pediatric abdominal trauma: Evaluation by Computed Tomography. J Am Acad Pediatr. 1988;82(1):11-5.

Canty T, Carlos B. Injuries of the GI tract from blunt trauma in children: a 12 year experience at a designated pediatric trauma centre. J Trauma. 1999;46(2):234-40.

Ozturk H, Otcu S, Onen A. Retroperitoneal organ injury caused by anterior penetrating abdominal injury in children. Eur Jr Emerg Med. 2003;10(3):164-5.

Wang M, Anthony K, Pamela M. Injuries from falls in the pediatric population: an analysis of 729 cases. J Pediatr Surg. 2001;36(10):528-1534.

Deluca J, Maxwell D, Flaherty S. Injuries associated with pediatric liver trauma. J Am Surg. 2007;73(1):37-45.

Chirdan LB, Uba AF, Yiltok SJ. Pediatric blunt abdominal trauma: challenges of management in a developing country. Eur Jr Pediatr Surg. 2007;17(2):90-5.

Henderson CG, Sedberry-Ross S, Pickard R. Management of high-grade renal trauma: 20-year experience at a pediatric level I trauma center. J Urol. 2007;178(1):246-50.

Hugo T, Jukema G, Bode P. Pediatric Splenic Injury: non-operative management first! Eur J Trauma and Emerg Surg. 2008;34(3):267-72.

Jim J, Leonardi MJ, Cryer HG. Management of high-grade splenic injury in children. Ann. Surg. 2008;74(10):988-92.

Bowman S, Zimmerman F, Christakis D. Hospital characteristics associated with the management of pediatric splenic injuries. JAMA. 2005;294(20):2611-7.

Stylianos S, Egorova N, Guice KS. Variation in treatment of pediatric spleen injury at trauma centers versus nontrauma centers: A call for dissemination of American Pediatric Surgical Association benchmarks and guidelines. J Am Coll Surg. 2006;202(2):247-51.

Navascues J, Matute J, Soleto J. Pediatric trauma in Spain. Eur J Pediatr Surg. 2005;15:30-37.