Abusive Abdominal Trauma—An Update for the Pediatric Emergency Medicine Physician

Abdominal injuries are uncommon but not rare in abused children and can be difficult to identify on clinical examination. Although occult abdominal injuries are likely to be self-limited, identifying an abdominal injury can dramatically affect the level of concern for abuse. Evidence supports routine screening with hepatic transaminases (aspartate aminotransferase and alanine aminotransferase) in children with concern for abuse, followed by intravenous contrast-enhanced computed tomography in those with an aspartate aminotransferase or alanine aminotransferase level higher than 80 IU/L. Because severe abdominal injuries are unlikely to result from minor or household trauma, young children who present with serious abdominal injuries in the absence of major trauma such as a motor vehicle crash should be carefully evaluated for the possibility of physical abuse.