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Emergency Medicine


Answer 4
  1. Transfer to a trauma center for further management. The decision to transfer a patient who has sustained a traumatic injury is based on several criteria. The mechanism of injury must be assessed to determine the potential for occult injury. In this patient, the presence of a ̉seat belt sign” is a clue to possible underlying abdominal injury. Pediatric patients with a seat belt sign have a 3 times greater chance of having an underlying abdominal injury and are almost 13 times as likely to have a gastrointestinal injury.4 This child was suboptimally restrained, which increases his risk to sustain intra-abdominal injury threefold. The mechanism of injury and the lower abdomen ecchymosis suggests that this child should be transferred to a trauma center. Despite a negative FAST scan, it would be unsafe to discharge this patient home, even after 4 hours. Ultrasound is not adequate to exclude intra-abdominal injury in this setting. Plain radiographs of the abdomen are not recommended in the trauma patient. DPL is not indicated in a blunt trauma patient with normal vital signs.5

    REFERENCES
    4. Nance ML, Lutz N, Arbogast KB, et al. Optimal restraint reduces the risk of abdominal injury in children involved in motor vehicle crashes. Ann Surg 2004;239:127-31.

    5. Sokolove PE, Kuppermann N, Holmes JF. Association between the “seat belt sign” and intra-abdominal injury in children with blunt torso trauma. Acad Emerg Med 2005;12:808-13.

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