| Abstract: OBJECTIVE : It is thought that the sequelae of significant abdominal trauma and the response to resuscitation can increase intra-abdominal pressures and lead to abdominal compartment syndrome (ACS). Normal post-injury abdominal pressure is unknown in children. The objective of this study was to assess abdominal pressure in children following abdominal trauma.
METHODS : A prospective non-randomized study was performed in children admitted to a Level I Pediatric Trauma Center following penetrating or blunt abdominal injuries. Patient demographics, injury mechanisms and treatment modalities were recorded. Bladder pressures were measured on regular intervals for those patients with a Foley catheter in place, and related to abdominal distention, cardio-respiratory status, urine output, hemoglobin levels and transfusion requirements. The Institutional Review Board approved the study.
RESULTS : Between June 2002 and June 2003, from 64 children admitted with abdominal trauma, 17 (15 blunt, 2 penetrating) had a Foley catheter and were enrolled in the study. The population had a mean age of 10.8 years (range, 1 to 16 years) and a mean ISS of 23 (range, 9 to 43). All children had at least one abdominal injury of AIS >3. Abdominal surgery was performed in 5 (2 penetrating and 3 blunt). A mean of 746 ml of blood (range, 13 to 2400ml) was transfused in 5 children. A mean of 6 abdominal pressures per child were measured (range, 1 to 14). The first pressures were recorded a mean 9.9 hours post-injury (range, 1 to 29) and had a mean of 5.8 mmHg (range, 1 to 13). The mean peak abdominal pressure, recorded a mean 27.6 hours post-injury was 8.6 mmHg (range, 3 to 20). Only one abdominal pressure reached 20 mmHg. Presence of abdominal distention and volume of transfusion did not significantly change abdominal pressures. No ACS was encountered.
CONCLUSIONS : Most children with significant abdominal injuries had normal or slightly raised abdominal pressures independent of clinical parameters. Up to a measurement of 20 mmHg, ACS was not encountered.
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