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Characteristics and predictors of intensive care unit admission in pediatric blunt abdominal trauma

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Abstract

Background

Pediatric trauma patients sustaining blunt abdominal trauma (BAT) with intra-abdominal injury (IAI) are frequently admitted to the intensive care unit (ICU). This study was performed to identify predictors for ICU admission following BAT.

Methods

Prospective study of children (< 16 years) who presented to 14 Level-One Pediatric Trauma Centers following BAT over a 1-year period. Patients were categorized as ICU or non-ICU patients. Data collected included vitals, physical exam findings, laboratory results, imaging, and traumatic injuries. A multivariable hierarchical logistic regression model was used to identify predictors of ICU admission. Predictive ability of the model was assessed via tenfold cross-validated area under the receiver operating characteristic curves (cvAUC).

Results

Included were 2,182 children with 21% (n = 463) admitted to the ICU. On univariate analysis, ICU patients were associated with abnormal age-adjusted shock index, increased injury severity scores (ISS), lower Glasgow coma scores (GCS), traumatic brain injury (TBI), and severe solid organ injury (SOI). With multivariable logistic regression, factors associated with ICU admission were severe trauma (ISS > 15), anemia (hematocrit < 30), severe TBI (GCS < 8), cervical spine injury, skull fracture, and severe solid organ injury. The cvAUC for the multivariable model was 0.91 (95% CI 0.88–0.92).

Conclusion

Severe solid organ injury and traumatic brain injury, in association with multisystem trauma, appear to drive ICU admission in pediatric patients with BAT. These results may inform the design of a trauma bay prediction rule to assist in optimizing ICU resource utilization after BAT.

Study design

Prognosis study.

Level of evidence

1.

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Abbreviations

IAI:

Intra-abdominal injury

MVC:

Motor vehicle collision

BAT:

Blunt abdominal trauma

SOI:

Solid organ injury

ICU:

Intensive care unit

CT:

Computed tomography

SI:

Shock index

GCS:

Glascow coma scale

TBI:

Traumatic brain injury

LOS:

Length of stay

IQR:

Interquartile range

ISS:

Injury severity score

cvAUC:

Cross-validated area under the curve

ROC:

Receiver operating characteristic curve

AOR:

Adjusted odds ratio

CI:

Confidence interval

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Funding

No funding was used to conduct this research.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Texas Children’s Hospital, Baylor College of Medicine, 6701 Fannin Street #1210, Houston, TX, 77030, USA

    Steven C. Mehl, Megan E. Cunningham, Rowland Pettit, Bindi J. Naik-Mathuria & Adam M. Vogel

  2. Medical University of South Carolina Children’s Hospital, Charleston, SC, USA

    Christian J. Streck

  3. Le Bonheur Children’s Hospital, Memphis, TN, USA

    Eunice Y. Huang

  4. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Matthew T. Santore

  5. Children’s Memorial Hermann Hospital, Houston, TX, USA

    Kuojen Tsao

  6. Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Richard A. Falcone

  7. Arkansas Children’s Hospital, Little Rock, AR, USA

    Melvin S. Dassinger

  8. Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA

    Jeffrey H. Haynes

  9. Children’s Hospital of Alabama, Birmingham, AL, USA

    Robert T. Russell

  10. Children’s Mercy Hospital Kansas City, Kansas City, MO, USA

    Shawn D. St. Peter

  11. Boston Children’s Hospital, Boston, MA, USA

    David Mooney

  12. LA Children’s Hospital, Los Angeles, CA, USA

    Jeffrey Upperman

  13. Vanderbilt University Medical Center, Nashville, TN, USA

    Martin L. Blakely

Authors
  1. Steven C. Mehl
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  2. Megan E. Cunningham
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  3. Christian J. Streck
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  4. Rowland Pettit
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  5. Eunice Y. Huang
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  6. Matthew T. Santore
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  7. Kuojen Tsao
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  8. Richard A. Falcone
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  9. Melvin S. Dassinger
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  10. Jeffrey H. Haynes
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  11. Robert T. Russell
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  12. Bindi J. Naik-Mathuria
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  13. Shawn D. St. Peter
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  14. David Mooney
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  15. Jeffrey Upperman
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  16. Martin L. Blakely
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  17. Adam M. Vogel
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Corresponding author

Correspondence to Adam M. Vogel.

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The authors have no potential conflicts of interest to disclose.

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All procedures performed in studies involving human participants were in accordance with the ethical standard of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Mehl, S.C., Cunningham, M.E., Streck, C.J. et al. Characteristics and predictors of intensive care unit admission in pediatric blunt abdominal trauma. Pediatr Surg Int 38, 589–597 (2022). https://doi.org/10.1007/s00383-022-05067-5

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  • DOI: https://doi.org/10.1007/s00383-022-05067-5

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