Management of pediatric blunt abdominal trauma with split liver or spleen injuries: a retrospective study

Area of Science:

• Pediatric Traumatology
• Diagnostic Imaging
• Emergency Medicine

Background:

• Blunt abdominal trauma is a leading cause of pediatric injury, morbidity, and mortality.
• Contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) are key for stable pediatric patients.
• Accurate diagnosis is crucial for effective management of these injuries.

Purpose of the Study:

• To evaluate the clinical experience with CEUS and CECT in managing pediatric split liver and spleen injuries.
• To assess the diagnostic utility of CEUS in conjunction with CECT for blunt abdominal trauma.
• To establish an effective decision-making algorithm for pediatric trauma patients.

Main Methods:

• A 5-year retrospective study of 246 children with blunt abdominal trauma across three tertiary hospitals.
• Implementation of the Advanced Trauma Life Support (ATLS) protocol for initial resuscitation.
• Utilized a diagnostic algorithm incorporating FAST, baseline ultrasound, CEUS, and CECT for patient management based on imaging and stability.

Main Results:

• CECT identified spleen injuries in 62% and liver injuries in 32% of patients; 6% had both.
• CEUS detected 57.7% of spleen injuries and 27.2% of liver injuries.
• Road traffic accidents were the primary cause of trauma in 63% of cases.

Conclusions:

• CEUS shows promise as a diagnostic tool for hemodynamically stable children with low-to-moderate blunt abdominal trauma.
• CEUS can aid in clarifying uncertain CECT findings and monitoring conservatively managed injuries.
• Integrating CEUS into the diagnostic pathway can optimize management of pediatric abdominal trauma.