Abusive Abdominal and Thoracic Trauma

Abdominal trauma is the second most common cause of death due to abuse, with the reported mortality rate as high as 40% to 50%. The infrequent and inconsistent use of screening studies in abused patients without abdominal findings may result in both a lower reported incidence and a higher reported mortality rate for abusive abdominal injuries. The young age of a large percentage of abuse victims, neurologic impairment due to concomitant brain injury or hemodynamic compromise, and the common delay in seeking care all impact the reliability of clinical findings related to abdominal trauma. In abuse patients, liver enzyme levels can be elevated without clinical signs of abdominal trauma, and liver lacerations have been diagnosed by computed tomography scan in patients without obvious abdominal trauma. An evaluation for occult abdominal trauma should be considered in patients being evaluated for possible physical abuse. This article will review both common and occult presentations of abusive abdominal trauma and will briefly discuss thoracic injuries as well.