Original article
Blunt Abdominal Trauma in Children: A Score to Predict the Absence of Organ Injury

https://doi.org/10.1016/j.jpeds.2009.01.001Get rights and content

Objectives

To evaluate the initial workup and design a score that would allow ruling out significant intra-abdominal organ injuries following blunt abdominal traumas (BAT).

Study design

Data were collected prospectively from 147 consecutive patients admitted for BAT in a tertiary care hospital, over a 30-month period.

Results

Statistical significance of various parameters (trauma mechanism, clinical examination, laboratory tests, and ultrasound findings) were analyzed in relation to intra-abdominal injuries. The 10 parameters with the best negative predictive values (NPV) were then used to build a score (BATiC). The following points were attributed for these items: abnormal abdominal Doppler ultrasound (4 points), abdominal pain (2 points), peritoneal irritation (2 points), hemodynamic instability (2 points), aspartate aminotransferase >60 IU/L (2 points), alanine aminotransferase >25 IU/L (2 points), white blood cell count >9.5 g/L (1 point), LDH >330 IU/L (1 point), lipase >30 IU/L (1 point), and creatinine >50 μg/L (1 point). A score of ≤7 has a NPV of 97% and includes 67% of the studied population.

Conclusions

These results suggest that in hemodynamically stable patients with a normal abdominal Doppler ultrasound and a BATiC score of ≤7, intra-abdominal lesions are very unlikely, and systematic CT scan or hospital admission may be avoided.

Section snippets

Methods

A prospective study was designed following the guidelines in use in our institution and received research ethics board approval. Data were collected for all patients consecutively admitted after blunt abdominal trauma from October 1, 2003, to March 31, 2006.

According to the guidelines existing in our institution, children with BAT admitted to our emergency department (ED) were clinically assessed and submitted to the following tests (initial workup): full blood cell count, coagulation tests,

Results

During the 30-month study period, 163 patients were admitted following BAT; the mean age was 10.1 ± 3.9 years, with a sex ratio (male to female) of 1.71. The mean time from trauma to blood workup was 1.7 ± 0.7 hours. Sixteen patients were excluded a posteriori, because they were not managed per protocol (either because they had a CT scan before a Doppler US or because they were not admitted for observation). Among the other 147 patients, 48 were excluded from the BATiC analysis because there

Discussion

After BAT in a child, the physical examination is not reliable enough to rule out all significant intra-abdominal organ lesions.12, 13, 14 Therefore, physicians rely on biological markers of organ injury, such as AST and ALT, and on radiological assessment. The most sensitive and specific examination for the identification of an intra-abdominal injury is an abdominal CT scan, with an estimated NPV of 99.8%.1, 3 Nevertheless, this examination is irradiating, expensive, and may necessitate

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    The authors declare no conflicts of interest.

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