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. 2026 Sep 9;7(5):100493. doi: 10.1016/j.acepjo.2026.100493

Evaluation of Pediatric Patients with Blunt Abdominal Trauma: A Systematic Review, Meta-Analysis, and Practice Management Recommendations

Samuel HF Lam 1,∗, Joyce Li 2, Dina Wallin 3, Michael J Stoner 4, Genevieve Santillanes 5, Mohsen Saidinejad 6, Kathleen Berg 7, Esther Ro 8, Jennifer Abueg 9, Newton Addo 10, Brian K Yorkgitis 11
PMCID: PMC13582007  PMID: 42755955

Abstract

Background

Computed tomography (CT) with intravenous contrast is a highly sensitive tool for diagnosis of injury following blunt abdominal trauma. However, the prevalence of clinically important intra-abdominal injury (CIIAI) in hemodynamically normal pediatric patients is less than 2%, and CT may not change management for many children since most pediatric intra-abdominal injuries do not require operative or procedural intervention. Ionizing radiation from CT is also associated with potential harms to children.

Methods

Three relevant questions related to imaging after abdominal trauma in pediatric patients were developed using clearly defined Population (P), Intervention (I), Comparison (C), and appropriately selected Outcomes (O) (PICO). A systematic review and meta-analysis was conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The multispecialty working group reached consensus on the final evidence-based recommendations.

Results

A total of 5141 articles were screened, and data from 13 studies were included in the meta-analysis. Most of the studies were retrospective, and the quality of the available evidence was determined to be very low.

Conclusions

In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma without signs of peritonitis: (1) We cannot make any recommendation regarding use of laboratory tests versus CT abdomen and pelvis as the initial screening test to identify CIIAI. (2) We cannot make any recommendation regarding the use of Focused Assessment with Sonography for Trauma (FAST) to identify CIIAI, or on the use of FAST to determine the need for further imaging. (3) We conditionally recommend CT abdomen and pelvis to identify CIIAI in pediatric patients with an abdominal seatbelt sign.

Keywords: pediatric blunt abdominal trauma, systematic review, meta-analysis, computed tomography imaging, ultrasound, laboratory tests

1. Introduction

Trauma is the leading cause of mortality in children in the United States.1 Blunt abdominal trauma is of particular concern, as pediatric patients have less musculature for organ protection, and proportionally larger solid organs that extend beyond the costal margin. Although head trauma is the leading cause of trauma-related death in pediatric patients, death occurring less than 6 hours after injury is often attributable to hemorrhage.2, 3, 4 Patients with severe abdominal organ injury can have significant blood loss, and blunt abdominal trauma is the third most common cause of death from trauma in children.5

Approximately 6% of pediatric patients with torso trauma sustain intraabdominal injury.6 However, most of these injuries are managed nonoperatively. This includes up to 97% of spleen, liver, and renal injuries and up to 83% of pancreatic injuries.7, 8, 9, 10, 11, 12, 13, 14 Although gastrointestinal tract, abdominal vascular, and bladder rupture injuries often require surgery,15, 16, 17 limited data suggest that these injuries are relatively rare (2% or less of the torso injury population).6,18, 19 On the other hand, radiation from medical imaging is strongly associated with pediatric malignancy,20 and children are at an increased risk, given their relatively larger surface area to body size ratio and potentially longer lifelong radiation exposure compared with adults.21 One multicenter study in the United States (US) found that 14% to 25% of pediatric patients received an effective dose of 20 mSv or more with just one abdominal/pelvis computed tomography (CT) scan.22 This same study estimated that one radiation-induced solid cancer would result from every 300 to 390 abdomen/pelvis CTs in girls, and every 670 to 760 abdomen/pelvis CTs in boys. Several other studies have similarly found increased cancer risk in association with increased radiation dosing.23, 24, 25, 26 Therefore, it is important to balance identification of severe injuries requiring intervention with the potential harms from diagnostic imaging studies involving ionizing radiation.

Although CT is generally considered the gold standard for imaging in trauma, other tools are available to help evaluate for serious injuries in pediatric patients following abdominal trauma. Laboratory tests such as liver enzymes, additional imaging such as Focused Assessment with Sonography for Trauma (FAST) examination, and physical exam findings such as the “seatbelt sign” (abdominal bruising on the anterior abdomen) may have utility in aiding decision-making regarding the need for further evaluation and treatment. The Eastern Association for the Surgery of Trauma (EAST) published guidelines on diagnostic approaches to blunt abdominal trauma in 2002, but this was not specific to the pediatric population, and these guidelines were not developed with current methodology.27 The Pediatric Emergency Care Applied Research Network (PECARN) has developed a clinical decision instrument for identifying children at very low risk of clinically important blunt abdominal injuries, based on history and physical examination findings, but did not provide guidance on further workup for patients not classified as very low risk.6

The objective of our study was to use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to perform a systematic review and meta-analysis to generate evidence-based recommendations regarding the utility of laboratory tests, FAST, and abdominal seat belt sign to evaluate for clinically important intra-abdominal injuries.

Intra-abdominal injury has previously been defined as “any radiographically or surgically apparent injury to the following structures: spleen, liver, urinary tract (from the kidney to the urinary bladder), gastrointestinal tract (including the bowel or associated mesentery from the stomach to the sigmoid colon), pancreas, gallbladder, adrenal gland, intra-abdominal vascular structure, or traumatic fascial defect (traumatic abdominal wall hernia).” “Intra-abdominal injuries undergoing acute intervention” or “clinically important intra-abdominal injury” (CIIAI) is defined as an intra-abdominal injury associated with: death caused by the intra-abdominal injury, a therapeutic intervention at laparotomy, angiographic embolization to treat bleeding from the intra-abdominal injury, blood transfusion for anemia as a result of hemorrhage from the intra-abdominal injury, or administration of intravenous fluids (IVF) for 2 or more nights in patients with pancreatic or gastrointestinal injuries”.5 In a multi-institutional study enrolling over 12,000 pediatric patients presenting to EDs with blunt torso injuries, the prevalence of CIIAI was 1.7%, with an overall therapeutic laparotomy rate of 0.95% and mortality 0.07%.6

2. Methods

The review was developed by a working group of pediatric emergency physicians, general emergency physicians, pediatric surgeons, and a pediatric radiologist, representing practice in both academic and community settings. Outcomes were selected in accordance with GRADE methodology.28 Three relevant questions related to imaging after abdominal trauma in pediatric patients were developed using Population (P), Intervention (I), Comparison (C), and Outcome (O) (PICO) format. Candidate outcomes were generated by group discussion and consensus. Each author voted anonymously and independently on a platform administered by the Pediatric Trauma Society on each outcome using a scale of 1-9. Outcomes with scores 7 to 9 were considered critical outcomes and were included in our analysis. Outcomes with scores 4 to 6 were considered important outcomes, and outcomes with scores 1 to 3 were considered of limited importance. Important and limited importance outcomes were not included in our analysis. This voting process was repeated when making practice recommendations for the PICO questions.

A composite outcome was determined to be a critical outcome, and this was CIIAI. Radiation exposure (in mSv) was considered a critical outcome for the PIC stems addressing CT imaging. Performance of further imaging was considered a critical outcome for the PIC stem addressing FAST.

The following PICO questions were formulated prior to literature search:

PICO 1: In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma without signs of peritonitis but with concern for abdominal injury (P), should the initial screening test be blunt abdominal trauma specific laboratory tests∗ (I) versus an immediate CT abdomen and pelvis with intravenous (IV) contrast to identify CIIAI∗∗ (O1) and to limit radiation exposure (O2)?

PICO 2: In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma without signs of peritonitis but with concerns for abdominal injury (P), should FAST (I) versus no FAST (C) be performed to identify CIIAI (O1) and to determine need for further imaging (O2)?

PICO 3: In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma with an abdominal seatbelt sign∗∗∗ but without signs of peritonitis (P), should CT abdomen and pelvis with IV contrast (I) versus no CT (C) be performed to identify CIIAI (O1) and to limit radiation exposure (O2)?

2.1. Identification of References

A research librarian (JA) assisted in the development of a systematic search strategy used to identify references of interest in MEDLINE (PubMed), Embase, Scopus, and the Cochrane Library. (Supplementary Fig 1). The search included publications from July 1, 1963 through October 31, 2024 and was completed on November 7, 2024. Published observational and randomized studies that included patients receiving both the intervention and comparator were eligible for review. Case series, case reports, commentaries, animal studies, operative technique articles, and any studies not published in English were all excluded. Review articles were not eligible for inclusion in the systematic review, but these were identified, and citations reviewed to ensure any relevant primary studies were included in our results. Titles and abstracts were reviewed for inclusion in duplicate by 2 separate team members, and conflicts were adjudicated by a third team member. Full texts identified for inclusion were also reviewed for inclusion in duplicate by 2 separate team members, and conflicts were adjudicated by a third team member. All reviews were conducted using Covidence (www.covidence.org). The study was registered with PROSPERO (CRD42022310324).

2.2. Data Extraction and Management

Data were extracted in duplicate using Excel (Microsoft, Redmond, WA) and data analysis was conducted using RevMan Online (revman.cochrane.org) and R (version 4.5). All included studies reported sufficient data to construct 2×2 contingency tables for the outcome of CIIAI. Reported values included true positives (TP), false positives (FP), false negatives (FN), and true negatives (TN), which allowed for the calculation of diagnostic test characteristics for each study. In 8 studies, 2×2 values were manually derived based on published counts or percentages due to incomplete reporting. Where it was unclear whether these numbers could be derived, one review author (SL) contacted the studies’ primary or corresponding authors for additional details. These raw data informed both the forest plots and the pooled estimates of diagnostic accuracy. Pooled estimates were calculated using a bivariate random effects model. Confidence intervals were computed using the Wilson score method implemented in the mada package. Heterogeneity was calculated and quantified with Holling’s sample size-adjusted I2. A low degree of heterogeneity was considered I2 values less than 50%, those with moderate heterogeneity had I2 values between 50% and 74%, and high heterogeneity was considered I2 values greater than 75%.29

For PICO 3, odds ratios (and 95% confidence intervals) for dichotomous outcomes and differences in means (and 95% confidence intervals) were calculated for the intervention groups and comparison groups. Statistical significance was considered P < .05.

2.3. Methodological Quality Assessment

This review adhered to the validated GRADE methodology.30,31 The quality of the evidence was assessed with GRADEPro (www.gradepro.org). Risks of bias, inconsistency, indirectness, imprecision, and publication bias were all considered. Based on the results of the meta-analyses and the evidence quality, all members of the working group then voted on recommendations for each PICO question. Factors taken into consideration in making the recommendations include (1) Balance of benefits and harms, (2) Resource consideration, and (3) Quality of evidence.

3. Results

A total of 5141 articles met the initial search definitions. After abstract and title screening, 322 manuscripts were identified for full text review. Ultimately, data from 13 studies were included in the final meta-analysis (Fig 1). Most (10, 76.9%) were retrospective studies. Year of publication ranged from 1998 to 2022.

Figure 1.

Figure 1

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses

flow diagram for study selection for analysis.

∗Reasons for exclusion

57 Nonpediatric

32 Wrong intervention

27 Wrong patient population

24 Review Article

23 Non-English

16 Too old

16 Wrong outcomes

16 Wrong article type

7 Wrong setting

4 Wrong comparator

3 Commentary

2 Abstract only

1 Wrong indication.

3.1. PICO 1: Quantitative Synthesis

We found 8 studies with data available to answer this PICO question.32, 33, 34, 35, 36, 37, 38, 39 All except one were retrospective studies. There were no randomized controlled trials. Four of the studies focused on liver injury, 1 focused on pancreatic injury only, whereas 3 focused on general abdominal solid and hollow viscus injuries. Laboratory tests included AST, ALT, lipase, amylase, urinalysis, and hematocrit. Cutoff values for normal varied among studies, particularly AST and ALT. None of the studies quantified radiation exposure in patients who underwent CT.

A total of 5024 patient encounters were included in the 8 studies, with 208 comparative diagnoses of CIIAI. Sensitivity ranged from 17% to 94% for laboratory tests and 50% to 99% for CT. Pooled sensitivity and specificity were calculated. The pooled sensitivity and specificity for blunt abdominal trauma specific laboratory tests were 50% (95% CI 40 to 60) and 72% (95% CI 45 to 89), respectively. The pooled sensitivity and specificity for CT imaging were 94% (95% CI 85 to 98) and 65% (95% CI 39 to 84), respectively.

Figure 2A displays the forest plot of study-level and pooled sensitivity and specificity estimates for laboratory tests and CT imaging. I2 was 5.8 to 23.3% for CT and 3.4 to 5.3% for blunt abdominal trauma specific laboratory tests, suggesting low to moderate heterogeneity among studies. The diagnostic odds ratio (DOR) was calculated for each strategy, with a pooled DOR of 43.7 (95% CI 5.65 to 162.0) favoring CT (P < .001). Figure 2B details the risks of bias of the included studies.

Figure 2A.

Figure 2A

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Forest plots of sensitivity and specificity of laboratory tests and computed tomography (CT) scan for PICO question 1.

Figure 2B.

Figure 2B

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Risks of bias for included studies.

3.2. PICO 1: Grading the Evidence

Certainty of outcome effect was assessed using the GRADE framework. The overall certainty of evidence was determined to be very low (Supplemental Fig. 2).

3.3. PICO 1: Recommendation

There is currently a paucity of data on the comparative mSV value to fully weigh the risk of laboratory tests versus CT scan. Though CT scans tend to utilize more resources than laboratory tests, both are readily available in most hospital EDs in the US. The working group discussed the lack of comparative radiation risk combined with the overall low quality of data, and decided that no definitive recommendation could be made, as risks of harm from CT scan were not adequately evaluated with the available evidence.

In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma without signs of peritonitis but with concern for abdominal injury, based on insufficient and low-quality evidence, we cannot make any recommendation regarding whether the initial screening test should be blunt abdominal trauma specific laboratory tests versus an immediate CT abdomen and pelvis with IV contrast to identify CIIAI.

3.4. PICO 2: Quantitative Synthesis

We found only 2 studies with available data to answer this PICO question. Both were prospective studies using FAST (if performed) to determine further imaging.40,41 Only one of the studies was a randomized controlled trial, enrolling 925 patients.41

For the first outcome, 17 patients were found to have CIIAI, and 1285 patients had FAST performed. On the other hand, there were 37 cases of CIIAI in 1824 patients who did not have FAST performed but went on to further imaging. Pooled sensitivity and specificity were calculated for FAST and further imaging without FAST. The pooled sensitivity and specificity for FAST were 57% (95% CI 27 to 82) and 96% (95% CI 73 to 99), respectively. The pooled sensitivity and specificity for further imaging without FAST were 94% (95% CI 91 to 96) and 100% (95% CI 99 to 100), respectively. Figure 3A displays the forest plot of study-level estimates for FAST vs. further imaging without FAST (No FAST). I2 was 0% for FAST and 2.3 to 3.7% for further imaging without FAST, suggesting low heterogeneity among studies. Figure 3B details the risks of bias of the included studies.

Figure 3A.

Figure 3A

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Forest plots of sensitivity and specificity of FAST vs no-FAST for PICO question 2 outcome 1 (CIIAI).

Figure 3B.

Figure 3B

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Risks of bias for included studies.

Because of the presence of one or more cells in the 2×2 contingency table containing zero events, the resulting estimated diagnostic odds ratio approached infinity even with a continuity correction. Considering both the sparsity of the evidence and the instability of this estimate, we did not consider this pooled DOR to be reliable or clinically interpretable.

For the second outcome, 581 out of 1289 patients who had FAST performed underwent further imaging. On the other hand, further imaging was performed in 881 out of 1824 patients who did not have FAST performed. Aggregate OR was 0.84 favoring patients with FAST performed (95% CI 0.73 to 0.97). Heterogeneity was negligible with I2 of 0%. Figure 4 presents a forest plot of the meta-analysis results.

Figure 4.

Figure 4

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Forest plots of the meta-analysis results for PICO question 2 outcome 2 (further imaging).

3.5. PICO 2: Grading the Evidence

Certainty of outcome effect was assessed using the GRADE framework (Supplemental Fig 3). The overall certainty of evidence was determined to be very low for both outcomes.

3.6. PICO 2: Recommendation

FAST exam does not cause any direct harm to patients, but a false positive FAST may lead to unnecessary further studies including CT. From the best available evidence, there is overall minimal to null effect of FAST on the selected outcomes. FAST generally requires minimal additional resources other than the purchase and maintenance of the ultrasound machine and is widely available across practice settings. The overall quality of evidence available was very low. Based on limited, contradictory, and very low-quality evidence showing no clear benefit, the group decided to make no recommendation on the use of FAST for the chosen outcomes.

In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma without signs of peritonitis but with concerns for abdominal injury no recommendation can be made regarding the use of FAST to identify CIIAI, or to determine the need for further imaging.

3.7. PICO 3: Quantitative Synthesis

We found 3 studies with available data to answer this PICO question.42, 43, 44 Two were retrospective studies. None of the studies quantified radiation exposure in patients who underwent CT.

A total of 65 patients were found to have CIIAI out of 742 patients who underwent CT imaging. History and physical examination alone detected 1 CIIAI in 714 patients screened. Calculated ORs varied from 3.84 to 86.94 favoring CT. Aggregate OR was 18.7 favoring CT (95% CI 2.33 to 149.87). Heterogeneity was moderate with I2 of 48%. Figure 5 presents a forest plot of the meta-analysis results. Of note, 7 patients with CIIAI had normal initial abdominal and pelvic CTs.

Figure 5.

Figure 5

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Forest plot of the meta-analysis results for PICO question 3.

3.8. PICO 3: Grading the Evidence

Certainty of outcome effect was assessed using the GRADE framework. The overall certainty of evidence was determined to be very low (Supplemental Fig 4).

3.9. PICO 3: Recommendation

The working group strongly considered the potential harm of radiation from CT abdomen and pelvis with IV contrast for evaluation of children with abdominal seatbelt sign. Compared with the study population in PICO 1 and PICO 2, the number of children presenting with seatbelt sign is much lower, but the prevalence of CIIAI is almost 3 times higher (2-4% vs. 9%). In addition, the 3 reviewed studies demonstrated uniformity and relatively large magnitude of the intervention (CT) effect. Based on the overall more favorable benefit to risk profile and much smaller population impact of radiation, the group decided to support using CT to identify CIIAI. Although the quality of the evidence was low, this was primarily due to the paucity of studies published on this particular question. Nevertheless, this was the reason why the group was only able to make a conditional recommendation.

In hemodynamically normal pediatric patients (<18 years) with blunt abdominal trauma with an abdominal seatbelt sign but without signs of peritonitis, we conditionally recommend CT of abdomen and pelvis with IV contrast be performed to identify CIIAI.

4. Discussion

We conducted a systematic review and meta-analysis of the current literature examining imaging of pediatric patients after blunt abdominal trauma using the GRADE methodology. We did not find sufficient evidence to recommend the use of blunt abdominal trauma specific laboratory tests or FAST examination as standalone screening tests in the evaluation of hemodynamically normal pediatric patients with blunt abdominal trauma. However, we did find sufficient evidence to conditionally recommend abdominal and pelvic CT with IV contrast in hemodynamically normal pediatric patients with an abdominal seatbelt sign to diagnose CIIAI, though the overall quality of evidence was determined to be very low.

Our findings are consistent with those of prior medical literature. In their review, Orwig concluded that abdominal CT is not warranted in pediatric blunt trauma patients over 3-years-old with a normal physical examination combined with normal laboratory testing.45 On the other hand, Drexel46 concluded in a recent review that there is no single laboratory study value that can reliably predict intra-abdominal injury (IAI). In a systematic review and meta-analysis, Liang47 found that studies evaluating FAST have a pooled sensitivity of 35%, specificity of 96%, positive likelihood ratio of 10.84, and negative likelihood ratio of 0.64 in IAI in blunt pediatric abdominal trauma. They concluded that a positive FAST examination result means that IAI is likely, but a negative FAST examination result alone should not preclude further diagnostic workup for IAI. Similar conclusions were reached by authors examining the utility of FAST in the pediatric subpopulation.48,49 Additionally, a review in 2012 by Rentmeester found that seatbelt sign appears to be associated with an increased risk of IAI in children.50

In making recommendations on the PICOs 1 and 2, our group carefully considered risks and benefits of the interventions in question. Ideally, a test/ intervention would have high sensitivity to identify potentially life-threatening injuries, in addition to high specificity to avoid unnecessary downstream testing (particularly important in case of low prevalence events, such as CIIAI). Nevertheless, neither laboratory tests nor FAST fulfill these criteria when used as a screening test.

In our studies reviewed, CT is the most sensitive imaging modality for detection of CIIAI. It allows for timely diagnosis of these potentially life-threatening injuries which might occasionally be unobvious in young children presenting to the busy ED. Conversely, CTs are associated with considerable potential harms.20,22, 23, 24, 25, 26 Although there is no direct quantification of radiation exposure in any of our analyzed studies, it is clear that CT imaging is associated with increased risk of cancer in children. In addition, other potential downsides of CT include increased costs, increased hospital length of stay, and possibly increased downstream testing due to incidental or clinically insignificant findings on initial imaging. Furthermore, bowel perforation may not be evident on initial CT of the abdomen.51,52 Because of the low prevalence of CIIAI in children presenting to the ED with abdominal injury, the number needed to treat/image to find a case of CIIAI is high in our study population. According to previous cited radiation-induced malignancy risks, approximately 1 case of solid cancer would result per 10 cases of CIIAI identified if CT imaging were performed in all cases.22 This cancer risk is likely higher in the community or non-pediatric hospital setting, where pediatric imaging and dosing protocol might not be in place.53, 54, 55, 56 Hence, indiscriminate use of CT imaging to diagnose CIIAI cannot be recommended.

Recently, several investigators have explored the utility of risk stratification tools to accurately diagnose CIIAI while avoiding unnecessary CT in cases of low to moderate clinical suspicion. Instead of relying on a single test or imaging modality, they used a combination of history, physical examination, laboratory tests, FAST, and screening x-rays to identify children in whom CT may be indicated.39,57 In cases of hemodynamically normal children with equivocal findings or reasonable concern for CIIAI, admission for observation/ serial examination, or transfer without extensive imaging to a pediatric trauma center for evaluation by experienced personnel are also reasonable disposition options. We encourage health care organizations to develop evidence-based evaluation protocols of pediatric blunt abdominal trauma with respect to available local resources and expertise in conjunction with their pediatric trauma team or referral center with consideration for the risk of CIIAI along with radiation exposure. Future studies may be needed to evaluate the effectiveness of these strategies.

5. Limitations

The findings of our GRADE review were limited by the quality of the included studies. Many studies were retrospective in design. Prospective studies were mostly nonrandomized and unblinded, possibly introducing selection bias and reporting bias. The majority of the studies were conducted in academic, pediatric trauma referral center settings, which may have affected their applicability in community hospitals and lower-resourced settings. Study heterogeneity was moderate in most of the reviewed topics. For PICO 1, laboratory values may influence decisions to obtain CT imaging, introducing incorporation bias. Additionally, studies varied on cutoff values for laboratory testing and often did not include dose of radiation exposure. Not all children underwent definitive imaging for their injuries, leading to verification bias. The number of studies and subjects included was relatively small for PICO 3. Not all included studies uniformly reported different categories of CIIAI. The majority of reported CIIAI were transfusions and laparotomies/ angiographic embolization, and the total number in each case was limited. Hence, it was not feasible or clinically relevant to perform subgroup analysis on each category of CIIAI. Our group did not include a patient representative, so patient values and preferences were not directly taken into consideration in our recommendations.

6. Conclusions

In this systematic review and meta-analysis using GRADE methodology, we find insufficient evidence to recommend blunt abdominal trauma specific laboratory tests as standalone, initial screening tests to identify CIIAI. No recommendation could be made regarding use of FAST to identify CIIAI or to determine the need for further imaging. For patients presenting with an abdominal seatbelt sign, we conditionally recommend CT of abdomen and pelvis with IV contrast to identify CIIAI.

Funding and Support

By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.

Conflict of Interest

N. Addo is a cofounder and consultant to CaptureDx a company that develops or markets ultrasound-related technologies. The entity had no influence on the content or direction of the manuscript. The remaining authors have affirmed they have no conflicts of interest to declare.

Supervising Editor: Marianne Gausche-Hill, MD. Published on behalf of the American College of Emergency Physicians Pediatric Emergency Medicine Committee.

Supplementary material associated with this article can be found in the online version at https://doi.org/10.1016/j.acepjo.2026.100493.

∗

Blunt abdominal trauma specific laboratory tests: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), lipase, amylase, hemoglobin/hematocrit, lactate, urinalysis.

∗∗

CIIAI: death, laparotomy, angiographic embolization, blood transfusion, IVF administration for ≥2 nights for pancreatic/ intestinal injuries.

∗∗∗

seatbelt sign includes any bruising, abrasion, or persistent erythema on the anterior abdominal wall.

Supplementary Materials

Supplementary Material
mmc1.docx (21.4KB, docx)

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