Most Likely Injured Organ in Pediatric Blunt Abdominal Trauma
The spleen is the most likely organ injured in this 9-year-old with blunt abdominal trauma from a bicycle accident (Answer B). 1, 2, 3
Epidemiologic Evidence
The spleen is definitively the most commonly injured solid organ in pediatric blunt abdominal trauma across all age groups and mechanisms. 1, 2, 3 This holds true specifically for bicycle-related injuries, which represent a common mechanism in the pediatric population. 1
- The spleen accounts for the majority of solid organ injuries in children following blunt abdominal trauma, making it statistically the most probable source of this patient's upper abdominal pain. 1, 2
- Motor vehicle crashes and bicycle accidents are the predominant mechanisms causing splenic injury in pediatric patients. 1, 4
Clinical Reasoning in This Stable Patient
Since this child is hemodynamically stable, the non-conclusive FAST examination does not change the likelihood of splenic injury:
- FAST has limited sensitivity (50-92%, with meta-analyses suggesting ~66%) for detecting splenic injury in children, making a non-conclusive study expected and uninformative for ruling out injury. 5
- The low specificity of FAST in pediatric patients means that hemodynamically stable children with suspected intra-abdominal injury require contrast-enhanced CT scan as the gold standard for diagnosis, regardless of FAST results. 5
- Less than half of pediatric patients with abdominal injury have free fluid detectable on FAST, further limiting its utility in this population. 2
Next Steps for This Patient
This hemodynamically stable child requires contrast-enhanced CT scan of the abdomen to definitively identify and grade the splenic injury (or identify alternative injuries). 5
- CT scanning is specifically recommended in children at risk for injuries that might be missed by FAST, which includes this clinical scenario. 5
- The presence of upper abdominal pain following blunt trauma with a non-diagnostic FAST meets criteria for CT evaluation. 5
Why Not the Other Organs?
While liver, pancreas, and kidney injuries can occur in pediatric blunt trauma, they are significantly less common than splenic injury:
- Hepatic trauma occurs less frequently than splenic trauma in blunt abdominal injury patterns. 3
- Pancreatic trauma is uncommon and typically requires specific mechanisms like handlebar injuries with direct epigastric impact. 3
- Renal injuries are less common than splenic injuries in the overall pediatric trauma population. 3
Management Implications
Once splenic injury is confirmed on CT, this hemodynamically stable child should receive non-operative management (NOM) as first-line treatment, regardless of injury grade. 5, 6 NOM is successful in 95-100% of pediatric blunt splenic trauma patients who are hemodynamically stable at presentation. 5