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

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.

Abbreviations: ALT, Alanine aminotransferase, AST, Aspartate aminotransferase, AUC, Area under the ROC curve, aPTT, Activated partial thromboplastin time, BAT, Blunt abdominal trauma, BATiCscore, Blunt abdominal trauma in children score, BUN, Blood urea nitrogen, CK, Creatinine kinase, CK-MB, Creatinine kinase MB isoenzyme, CT, Computed tomography, ED, Emergency department, NPV, Negative predictive value, γ-GT, Gamma-glutamyltransferase, LDH, Lactate dehydrogenase, OIS, Organ injury score, PPV, Positive predictive value, PT, Prothrombin time, PTS, Pediatric trauma score, ROC, Receiver operating characteristic, US, Ultrasound scan, WBC, White blood cell