Chest, Abdominal, and Pelvic Injuries

Questions and Answers

Case: You are called to the scene of a moderate-speed (45 miles per hour) motor vehicle crash and find a 10-year-old female in the back seat, restrained with a seat belt. Her mother’s vehicle was “T-boned” on the driver’s side, causing the vehicle to rollover several times. She is awake and alert. Her vital signs are blood pressure 110/76, heart rate of 110 beats per minute, respiratory rate of 26 breaths per minute. Her Glasgow Coma Scale (GCS) score is 15. She denies any head injury, headache, loss of consciousness, or amnesia to the event. She denies any neck or back pain. She complains of mild chest pain associated with shortness of breath. She states that her “belly doesn’t hurt,” but when you transfer out of the vehicle, she has a seat belt sign noted just above her umbilicus. Her abdominal examination reveals mild tenderness on palpation without distention. Her chest, back, and extremities have no external evidence of trauma.

1 How common are chest and abdominal injuries in children?

Trauma is the leading cause of death and disability in children, and torso trauma is the second most frequent cause of death among children, following head injury. Blunt abdominal trauma accounts for approximately 80% of all abdominal trauma in children. Unfortunately, blunt abdominal trauma also accounts for the most common unrecognized fatal injury. Therefore, the prompt recognition and initial management of children with intraabdominal injury (IAI) following blunt torso trauma is of upmost importance in order to reduce morbidity and mortality.

2 What is the mechanism associated with chest and abdominal injuries in children?

Patterns of injury are usually related to age and stage of development. Falls predominantly occur between ages of 0 years to 9 years, with a peak incidence of 1 year to 4 years of age. Resultant injuries will range from soft tissue contusions and extremity fractures when heights are low. With heights >10 feet, polytrauma will result involving head, face, spine, abdomen, and extremities.

Pedestrians versus auto injuries can range in severity based on rate of speed, which can be minor from soft tissue and extremity fractures to polytrauma involving the head, chest, abdomen, and extremities.

Automobile accidents when unrestrained typically result in polytrauma involving the head, neck, abdomen and pelvis, and extremities. Restrained occupants are also at risk for polytrauma and have a risk of seat belt complex.

Bicycle handlebar injury to the abdomen typically results in injuries to liver, spleen, pancreas, and duodenum.

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