Pediatric Blunt Abdominal Trauma Evaluation and Management Pathways

Purpose of ReviewIdentification of children in whom a CT scan of the abdomen can safely be avoided to reduce unnecessary resource utilization, and radiation exposure remains a clinically relevant challenge. More than 90% of injured children are initially evaluated outside of a pediatric trauma center adding additional complexity to decision-making regarding the initial trauma evaluation. Management of solid organ injuries in children following blunt abdominal trauma continues to evolve. This chapter will review current clinical practice guidelines related to imaging and management of blunt abdominal trauma in children.Recent FindingsRecent pediatric studies provide clinical practice guidelines to identify children who are unlikely to require an acute intervention (surgery, transfusion, angiography) for abdominal trauma. In addition, guidelines utilizing labs and plain films to augment the physical exam help identify almost all children with a solid organ injury. More recent guidelines for management of identified solid organ injuries provide guidance on which patients require resources (labs, ICU admission, prolonged immobilization) and suggest that patients with low-grade solid organ injuries with no other major injuries could be safely discharged from the emergency department.Recent updates to clinical guidelines provide an opportunity to reduce variability in patient care and optimize resource utilization in children following blunt abdominal trauma.