Field triage of children with abdominal trauma

Seth W. Linakis, Julia K. Lloyd, David Kline, James F. Holmes, Rachel M. Stanley, Julie C. Leonard

Research output: Contribution to journalArticle

Abstract

Objective: Identify physical findings in children with abdominal trauma to inform prehospital providers regarding appropriate hospital destinations. Methods: This is a secondary analysis of the Pediatric Emergency Care Applied Research Network Abdominal Trauma Public Use Dataset. Children involved in motor vehicle collisions; struck by motor vehicles at >20 mph; involved in all-terrain vehicle, motorcycle, or scooter accidents; or who fell from >10 ft (n = 5575) were included. Stepwise multivariable multinomial logistic regression was used to compare clinical findings at presentation between children with no intra-abdominal injury, intra-abdominal injury without intervention, and intra-abdominal injury with intervention (laparoscopy/laparotomy, embolization, red blood cell transfusion, or admission >48 h on intravenous fluids). Results: Compared to children with no intra-abdominal injury, children with intra-abdominal injury (with and without intervention) were more likely to have evidence of abdominal wall trauma, abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and evidence of thoracic trauma. Children with intra-abdominal injury requiring intervention were more likely to have evidence of abdominal wall trauma (OR 3.32, 95% CI 2.03–5.44) and be intubated (OR 4.93, 95% CI 3.17–7.65) when compared to children with intra-abdominal injury without intervention. Conclusions: The findings of abdominal tenderness, peritoneal irritation, decreased breath sounds, distracting painful injury, and thoracic trauma may be used to identify children who warrant evaluation at any trauma center because of increased risk of intra-abdominal injury, whereas intubation and evidence of abdominal wall trauma help identify children with intra-abdominal injury in need of transport to a pediatric trauma center due to risk of undergoing intervention.

Original languageEnglish (US)
JournalTrauma (United Kingdom)
DOIs
StateAccepted/In press - 2020
Externally publishedYes

Keywords

  • abdominal injuries
  • Child
  • Emergency Medical Services
  • trauma center
  • triage

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

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  • Cite this

    Linakis, S. W., Lloyd, J. K., Kline, D., Holmes, J. F., Stanley, R. M., & Leonard, J. C. (Accepted/In press). Field triage of children with abdominal trauma. Trauma (United Kingdom). https://doi.org/10.1177/1460408620933524