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Pediatric abdominal injury patterns caused by "falls": A comparison between nonaccidental and accidental trauma
Kyle W Carter1, Steven L Moulton1
1University of Colorado School of Medicine, Aurora, CO 80045, United States; Department of Pediatric Surgery, Children's Hospital Colorado, 13123 E 16th Ave, Aurora, CO 80045, United States.
Insights
Pediatric nonaccidental trauma (NAT) often presents as blunt abdominal trauma (BAT). NAT victims show more severe head and internal injuries compared to fall-related incidents, warranting suspicion in young children with specific injury patterns.
Area of Science:
- Pediatric Trauma Surgery
- Abdominal Trauma
- Nonaccidental Trauma (NAT)
Background:
- Falling from a low height is the most common reported mechanism for pediatric nonaccidental trauma (NAT).
- Blunt abdominal trauma (BAT) in children necessitates careful evaluation to differentiate NAT from accidental injuries.
Purpose of the Study:
- To compare injury patterns in pediatric blunt abdominal trauma (BAT) patients.
- Differentiate injuries resulting from nonaccidental trauma (NAT) versus fall-related incidents.
Main Methods:
- Retrospective analysis of a regional pediatric trauma database.
- Inclusion of patients younger than five years evaluated for BAT.
- Comparison between nonaccidental trauma (NAT) victims and fall casualties.
Main Results:
- Sixty-five NAT cases and 115 fall casualties were identified.
- Nonaccidental trauma (NAT) victims exhibited higher Injury Severity Scores (ISS) and more severe head injuries (AIS).
- Hollow viscus and pancreatic injuries were more prevalent in NAT, while fall casualties more frequently sustained solid organ injuries.
Conclusions:
- Suspicion for nonaccidental trauma (NAT) is raised in children <5 years with BAT, severe head injury, hollow viscus/pancreatic injury, and high ISS.
- Isolated splenic or renal injuries may suggest an accidental fall rather than NAT.
Background/Purpose:
Falling from a low height is the most common history given by caregivers of pediatric nonaccidental trauma (NAT) victims evaluated for blunt abdominal trauma (BAT). The purpose of this study is to compare the patterns of injuries seen in children with BAT who are victims of NAT with those seen after a fall-related incident.
Methods:
Trauma database query from regional pediatric trauma centers identified patients were who were evaluated for BAT resulting from either NAT or a fall. Study groups included patients younger than five years who were (1) victims or NAT, or (2) fall casualties.
Results:
Sixty-five NATs and 115 fall casualties were identified. NAT victims had higher ISS, had more severe head injuries according to AIS scores, had more hollow viscus injuries, and had more pancreatic injuries. Fall casualties were more likely to have solid organ injuries.
Conclusions:
When evaluating children with a history of blunt abdominal trauma caused by a fall, suspicion for NAT is warranted if the child is younger than five years, has a hollow viscus, pancreatic, and/or severe head injury and has a high ISS. Likewise, isolated splenic or renal injury allays suspicion for NAT.
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