Blunt Abdominal Trauma in Children: A Score to Predict the Absence of Organ Injury
Received 18 September 2008; received in revised form 4 December 2008; accepted 5 January 2009. published online 23 February 2009.
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.
Pediatric Surgery Clinic, University of Geneva Children's Hospital, Geneva, Switzerland
Reprint requests: Dr Giorgio La Scala, Paediatric Surgery Clinic, University of Geneva Children's Hospital, 6 Rue Willy Donzé, CH – 1211 Geneva, Switzerland
ABSTRACT