In industrialized countries, injury is the primary cause of death in children, although most trauma does not result in death. Trauma is classified by the number of significantly injured body parts, the severity of the injuries, and the mechanism of injury: penetrating or blunt (Table 211.1). Firearm injuries are the most significant cause of penetrating trauma. Penetrating trauma is far less common in pediatric patients than adults, but when it does occur in children, it is likely to be in the adolescent age group. Blunt trauma, or blunt abdominal trauma (BAT), is usually caused by motor vehicle accidents (the most significant contributor), falls, impairments resulting from recreation, and assault. Coincidentally, the most affected organs of BAT are the liver and the spleen. Due to their retroperitoneal location, the kidney, pancreas, and duodenum are frequently spared significant injury after blunt trauma. In contrast to penetrating trauma, BAT accounts for 80% to 90% of all pediatric trauma.

Pediatric blunt trauma patients should be initially evaluated according to the advanced-trauma life support (ATLS) standards. First, as a part of the primary survey, evaluating the airways, breathing, and circulation (ABCs) is essential. An abbreviated neurologic assessment and a thorough injury search via complete patient exposure are appropriate during the primary survey as well. A secondary survey should focus on a complete, head-to-toe, physical examination to determine all traumatic injuries. About 24 hours after admission, a tertiary survey should also be conducted to once again perform a full, physical examination to assure that no injuries were previously missed.