Original articleBlunt Abdominal Trauma in Children: A Score to Predict the Absence of Organ Injury
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
References (24)
- et al.
Computed tomography for blunt abdominal trauma in the ED: a prospective study
Am J Emerg Med
(1998) - et al.
Imaging in pediatric blunt abdominal trauma
Semin Roentgenol
(2008) - et al.
Identification of children with intra-abdominal injuries after blunt trauma
Ann Emerg Med
(2002) - et al.
The pediatric trauma score as a predictor of injury severity in the injured child
J Pediatr Surg
(1987) - et al.
Organ injury scaling
Surg Clin North Am
(1995) - et al.
The value of physical examination in the diagnosis of patients with blunt abdominal trauma: a retrospective study
Injury
(1997) - et al.
Abdominal CT scanning in pediatric blunt trauma
Ann Emerg Med
(1988) An introduction to ROC analysis
Pattern Recognition Lett
(2006)- et al.
Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis
J Pediatr Surg
(2007) - et al.
Pediatric blunt abdominal trauma
Pediatr Clin North Am
(2006)
Abdominal and pelvic trauma in children
Crit Care Med
Abdominal injury score: a clinical score for the assignment of risk in children after blunt trauma
Radiology
Cited by (40)
Evaluation of an evidence-based guideline to reduce CT use in the assessment of blunt pediatric abdominal trauma
2021, Journal of Pediatric SurgeryCitation Excerpt :Institutional IRB approval was obtained. In 2013 our level I pediatric trauma center implemented an evidence-based guideline that was based on prior work by the guidelines committees of the Eastern Association for the Surgery of Trauma (EAST) and Pediatric Trauma Society (PTS) [14–19]. This guideline was modified slightly for our institution such that the decision for CT was driven by nonnormal findings in at least one assessment area including mental status, abdominal examination, focused assessment with sonography for trauma (FAST) exam, and laboratory results (aspartate aminotransferase (AST), alanine aminotransferase (ALT), hemoglobin (hgb), urinalysis) (Fig. 1).
An evidence-based algorithm decreases computed tomography use in hemodynamically stable pediatric blunt abdominal trauma patients
2020, American Journal of SurgeryCitation Excerpt :Evaluation of BAT in pediatric patients is challenging. While computed tomography (CT) is common practice for a pediatric BAT patient with strong evidence of intra-abdominal injury (IAI), (such as free fluid on a focused assessment using sonography in trauma (FAST) exam) or hemodynamic instability,3 there is variation in the management of hemodynamically stable pediatric BAT patients without those signs of IAI.4–8 Although abdominopelvic CT scan (CTAP) is considered the gold standard imaging modality for evaluating for IAI,2 a minority (estimated 10%) of pediatric BAT patients have IAI on CTAP,8 and most of those injuries are managed non-operatively.7,8
External validation of a clinical prediction rule for very low risk pediatric blunt abdominal trauma
2019, American Journal of Emergency MedicineCitation Excerpt :The benefit of identifying clinically important intra-abdominal injury (CIIAI) must be balanced with the risk of radiation-induced malignancy from abdominal CT. Several prediction rules have been proposed to risk-stratify these patients and to identify low-risk children in whom abdominal CT can be avoided [13-20]. In 2013, Holmes et al. published a prospective study through the Pediatric Emergency Care Applied Research Network (PECARN), which offered a clinical prediction rule to identify a cohort of children with BAT who are at very low-risk of CIIAI [21].
Imaging Gently
2018, Emergency Medicine Clinics of North America
The authors declare no conflicts of interest.