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Blunt trauma in children: significance of peritoneal fluid
C J Sivit1, G A Taylor, D I Bulas
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC 20010.
Insights
Computed tomography (CT) accurately detects peritoneal fluid in children with blunt trauma. Larger fluid collections correlate with hemodynamic instability, increased need for surgery, and higher mortality rates.
Area of Science:
- Pediatric Traumatology
- Radiology
- Emergency Medicine
Background:
- Blunt trauma in children often necessitates accurate injury assessment.
- Computed tomography (CT) is a key imaging modality for evaluating abdominal trauma.
- Identifying free peritoneal fluid is crucial for guiding management decisions.
Purpose of the Study:
- To prospectively evaluate the significance of peritoneal fluid collections detected by CT in children with blunt abdominal trauma.
- To correlate the size of peritoneal fluid collections with injury severity and clinical outcomes.
Main Methods:
- Seven hundred ninety children with blunt trauma underwent CT imaging without peritoneal lavage.
- Peritoneal fluid collections were categorized as small, moderate, or large.
- Correlation analysis was performed between fluid volume, injury patterns, hemodynamic status, and clinical outcomes.
Main Results:
- Peritoneal fluid was identified in a significant proportion of children.
- Increasing volumes of peritoneal fluid strongly correlated with hemodynamic instability, including lower trauma scores, arterial hypotension, and low hematocrit.
- The presence and amount of free fluid were significantly associated with the need for laparotomy and increased mortality.
Conclusions:
- CT-detected peritoneal fluid in pediatric blunt trauma is a reliable indicator of injury severity.
- The volume of free fluid is a critical factor in predicting clinical instability, surgical intervention, and patient outcomes.
- CT imaging plays a vital role in the risk stratification and management of pediatric blunt abdominal trauma.
Abstract:
Seven hundred ninety consecutively seen children who had not undergone peritoneal lavage underwent imaging with computed tomography (CT) after blunt trauma. Collections of peritoneal fluid were prospectively characterized as small (51 children), moderate (32 children), or large (40 children). Associated injuries included hepatic or splenic injury in 74%, isolated renal or pancreatic injury in 5%, isolated pelvic fracture in 5%, isolated hollow viscus injury in 5%, and a combination of the above in 7%. Peritoneal fluid was the only CT abnormality in three children. A significant correlation was found between presence and increasing size of peritoneal fluid collections and clinical signs of hemodynamic instability such as lower trauma score (P = .0008 by analysis of variance), the presence of arterial hypotension (P = .0001 by chi 2 test), and hematocrit less than 30% (0.30) (P = .0001 by chi 2 test). Additionally, the presence and amount of peritoneal fluid correlated with need for laparotomy and with mortality (P = .0001 by chi 2 test for both).