Purpose or Case Report: Abdominal injuries account for a relatively small percentage of non-accidental trauma. Previous estimates range from 0.5% to 11%. Despite this, abdominal injuries are the second leading cause of death in non-accidental trauma after head injury. Our objective is to assess the prevalence of abdominal injuries in the setting of suspected non-accidental trauma within a large urban children's medical center.
Methods & Materials: After IRB approval, from a database of nearly 3000 patients who were assessed for possible abuse from 1997-2012, 177 children with suspected non-accidental trauma who obtained both an abdominal CT and skeletal survey were identified. 3 patients diagnosed with systemic disease (tuberous sclerosis, neuroblastoma, and hepatoblastoma) were excluded. The resulting database consisted of 174 patients. All imaging studies including CT abdomen, CT brain and skeletal surveys were reviewed.
Results: Of the 174 patients, 72 were girls and 102 boys with age range from 1 to 139 months, mean age of 18 months. 30 patients (17 %) were found to have abdominal organ injuries, to include visceral, hollow organ, and vascular injuries.
These 30 patients were 21 boys, 9 girls with age range 1 month to 72 months, (mean age 29 months). Injuries included 22 liver (73%), 3 bowel (10%), 3 pancreatic (10%), 3 adrenal (10%), 1 renal (3%), 1 splenic (3%), 1 bladder (3%), and 1 aortic tear (3%). 13 of the 30 patients (43%) had intracranial injuries. 16 of the 30 patients (53%) had concurrent skeletal injuries, most commonly rib fractures (13/16, or 81%).
A separate group of 34 of the 174 patients (20%), 22 boys, 12 girls with age range 1 to 130 months (mean 21 months) had nonspecific abdominal CT findings including intraperitoneal fluid and equivocal abdominal organ injuries. 21 of these patients (62%) had intracranial injuries and 20 (59%) had skeletal injuries.
Conclusions: Abdominal organ injuries appear to be more common than previously reported in the literature. These findings support diligent screening for abdominal injuries in patients with suspected non-accidental trauma. Abdominal injuries are frequently accompanied by intracranial as well as skeletal injuries. A subgroup of patients with nonspecific/equivocal abdominal CT findings also had a high prevalence of associated intracranial and skeletal injuries; this group may warrant additional scrutiny.