Adult protection systems, such as seat belts, are often ill fitting or worn incorrectly, causing deceleration injuries to the upper abdomen.The bladder in babies is an intra-abdominal organ.The diaphragm is more horizontal, tending to push the liver and spleen lower below the rib cage.The liver and spleen take up a larger proportion of the abdominal cavity.The ribs are more pliable, providing less protection.The abdominal wall is relatively thin (less muscle & less subcutaneous fat), so it provides less protection.The relatively small size of the patient allows a single impact to injure multiple organ systems.Abdominal organs are relatively susceptible to injury because:.Abdominal injuries by injury typeģ0% of patients with abdominal injuries had an injury to one or more other body regions. RCH abdominal injury admissions by mechanism, 2000-2003 (n=220) A breakdown of these admissions by injury cause is given in Fig 1, with a breakdown of type of injuries sustained presented in Tableįig 1. Over the three-year period from Jto June 30, 2003, 271 abdominal injuries were recorded in 220 patients at the RCH. A high index of suspicion is needed, based on the child's history, to identify these injuries. However, the signs can be difficult to interpret in a scared, traumatised child. Significant abdominal injuries are relatively uncommon in childhood trauma. An institutional algorithm for blunt abdominal trauma management is supportive for emergency care in patients with handlebar injuries.Table of contents will be automatically generated here. We advocate close observation of patients with thoracic and abdominal handlebar injuries which may be regarded as blunt stab wounds. The spectrum of injuries in handlebar accidents varies widely, especially injuries to the abdomen can unmask often only in the course. Handlebar injuries in children resulted in serious trunk lesions in half of the present patient series. 20 children were referred by a family physician or a primary hospital after a median of 4.0 h (range 1-46 h). 20 children presented directly at our emergency unit after a median of 1.7 h (range 1-19.5 h). The overall duration between the accident and arrival at our emergency unit was 2.75 h (median, range 1-19 h). Overall median hospitalization duration was 4.5 days (range 1-19 days). The outcome was favorable in all the cases. Surgical interventions were performed in 8 patients. Diagnosed lesions were: ruptures of the liver (n = 6), spleen (n = 5), kidney (n = 1), and pancreas (n = 2), small bowel perforation (n = 3), and hernias of the abdominal (n = 2) or thoracic wall (n = 1). All children were treated according to an institutional algorithm.Ĥ0 patients with a median age of 9.5 years were included. We retrospectively assessed the charts of children below 16 years of age, only who were observed for 24 h or more in our institution due to a handlebar injury between 20. We present our experiences applying a diagnostic and therapeutic algorithm for blunt abdominal trauma, and present the history of two selected cases. Handlebar injuries in children may lead to severe organ lesions despite minimal initial signs and without visible skin bruise.