Main Article Content

Dr. Eliza Kapadia
Dr. Dharmendra Malviya


Blunt trauma, non-operative management, road traffic accident


Background - Blunt trauma accounts for more than 90% of traumatic mechanisms of injury in children. Blunt abdominal trauma accounts for between 10 and 15% of all blunt mechanisms. Children and young people are most often killed and disabled by accidents. The establishment of the present non- operative treatment for the majority of blunt solid organ injuries in the pediatric age group was prompted by observations that most blunt solid organ injuries will heal on their own and that surgical intervention would thwart this mechanism

Aim: this is a prospective observational study done in department of pediatrics surgery and radiology department in MGM Medical college and MY hospital Indore institute from January 2022 to July 2023. The aim of this study isRole of Radiology in management of blunt trauma abdomen in pediatric patients’ whether to conserve or operate at tertiary health care center in high patient load hospital in India.

Methodology: 116 patients with blunt abdominal trauma due to any cause, the medical records of all patients with trauma of any kind age up to 13 years were carefully reviewed. The injured organ, patient age, sex, injury grade, imaging findings, intervention, length of hospital stay, and complications were prospectively reviewed using medical records. Initial resuscitation was done according to ATLS protocol. Ultimate management decision was based on stability of patients after resuscitation. Data was entered and analyzed through SPSS-26. Chi- square test and student's t-test were applied and P value <0.05 was considered statistically significant.

Results: There are 116 patients included, mean age was 5.34 years. Most of the patients suffered from road traffic accident, 50(86.2%). 104 (89.65%) patients showed free fluid in the abdomen. Sonography picked organ injury in 104 (89.65 %) patients. Out of 108, 32 patients had spleen laceration, 56 liver and 20 renal injuries. 16 patients were having splenic as well as renal laceration. Only 2 patient (1.3%) showed isolated renal injury. Two patients also have pancreatic injury. CT abdomen with intravenous contrast confirmed findings of ultra sonography. Despite resuscitation, 12 (10.6%) patients remained unstable and were operated. 104 [89.4%] patients were kept on conservative treatment. Hospital stays ranged from 5-19 days. Pancreatic injury patient has more hospital stay.

Conclusion: BTA is common in boys under age of 10 years. Although non-operative management is the treatment of choice in blunt trauma abdomen with solid organ injury but stability of the injured child is the central pivot around which the whole management revolves. Delay in presentation and failure of timely resuscitation results into high operative intervention.

Abstract 24 | pdf Downloads 12


1. Centers for Disease Control and Prevention. National Center for Health Statistics. Leading causes of death and numbers of deaths, by age: United States, 1980 and 2016.
2. Leeper CM, Nasr I, Koff A, et al. Implementation of clinical effectiveness guidelines for solid organ injury after trauma: 10-year experience at a level 1 pediatric trauma center. J Pediatr Surg 2018; 53:775-9.
3. Gaines BA. Intra-abdominal solid organ injury in children: diagnosis and treatment. J Trauma 2009; 67:S135-9.
4. Streck CJ Jr, Jewett BM, Wahlquist AH, et al. Evaluation for intra- abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model? J Trauma Acute Care Surg 2012;73:371-76.
5. Miller M, Perlick C. Pediatric solid organ injury management: the role of initial hematocrit in LEAN times. J Emerg Crit Care Med 2019;3:39.
6. Gaines BA. Intra-abdominal solid organ injury in children: diagnosis and treatment. J Trauma 2009; 67(2): 135-9.
7. Loveland JA, Boffard KD. Damage control in the abdomen and beyond. Br J Surg 2004; 91: 1095-1101.
8. Pitcher RD, Wilde JCM, Douglas TS, Van AsAB. The use of the statscan digital X-ray unit in paediatric polytrauma. Pediatr Radiol 2009;39: 433-7.
9. McVay MR, Kokoska ER, Jackson RJ, Smith SD. Throwing out the ‘grade’ book: management of isolated spleen and liver injury based on hemodynamic status. J Pediatr Surg 2008; 43:1072-6.
10. Djordjevic I, Slavkovic A, Marjanovic Z, and Zivanovic D. Blunt trauma in paediatric patients – experience from a small centre. West Indian Med J 2015; 64(2):126-30.
11. Howard A, McKeag AM, Rothman L, Comeau JL, Monk B, German A. Ejections of young children in motor vehicle crashes. J Trauma 2003; 55:126-9.
12. Holmes JF, Sokolove PE, Brant WE, Palchak MJ, Vance CW, Owings JT, et al. Identification of children with intra-abdominal injuries after blunt trauma. Ann Emerg Med 2002; 39:500-509.
13. Tiwari C, Shah H, Jayaswal S, Waghmare M, Khedkar K, Dwivedi P. Conservative management of blunt abdominal trauma with solid organ injury in the paediatric age group: our experience. IJTEP 2016;8:215-9.
14. Velmahos GC, Zacharias N, Emhoff TA, Feeney JM, Hurst JM, Crookes BA, et al. Management of the most severely injured spleen. Arch Surg 2010;145:456-60.
15. Harbrecht BG, Ko SH, Watson GA, Forsythe RM, Rosengart MR, Peitzman AB. Angiography for blunt splenic trauma does not improve success rate of non-operative management. J Trauma 2007; 63:44-9.
16. Ameh EA, Chirdan LB, Nmadu PT. Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country. Pediatr Surg Int 2000; 16(7): 505-9.
17. Baiomy M, El-Ahmady R, Ahmed D, Mohammed M, Shokry S. A comparative study between conservative and early surgical intervention of solid organs injury after blunt abdominal trauma in paediatrics Ain Shams Medical J 2022; 73(1): 103-14.
18. Wisner DH, Kuppermann N, Cooper A, Menaker J, EhrlichP, Kooistra J, et al. Management of Children with solid organ injuries after blunt torso trauma. J Trauma Acute Care Surg 2015; 79: 206-14.
19. Coley BD, Mutabagani KH, Martin LC et al. Focused abdominal sonography for trauma (FAST) in children with blunt abdominal trauma. J Trauma 2000;48:902-6.
20. Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg 2007; 42: 1588-94.
21. Scaife ER, Rollins MD, Barnhart DC, Downey EC, Black RE, Meyers RL, et al. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Ped Surg 2013; 48: 1377-83.
22. Balcioglu ME, Boleken ME, Cevik M, Savas M, Boyacı FN. Blunt renal trauma in children: a retrospective analysis of 41 cases. Ulus Travma Acil Cerrahi Derg 2014; 20(2):132-5.
23. Rogers CG, Knight V, MacUra KJ, Ziegfeld S, Paidas CN, Mathews RI. High-grade renal injuries in children is conservative management possible? Urology 2004; 64: 574-9.
24. Fodor M, Primavesi F, Morell-Hofert D, Haselbacher M, Braunwarth E, Cardini B, Stättner S. Non-operative management of blunt hepatic and splenic injuries–practical aspects and value of radiological scoring systems. Eur Surg 2018; 50(6): 285-98.