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J Am Coll Surg. 2017 Apr;224(4):449-458.e3. doi: 10.1016/j.jamcollsurg.2016.12.041. Epub 2017 Jan 24.

Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely.

Author information

1
Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, SC. Electronic address: streck@musc.edu.
2
Department of Surgery, St Louis Children's Hospital, St Louis, MO.
3
Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, SC.
4
Department of Surgery, Le Bonheur Children's Hospital, Memphis, TN.
5
Department of Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
6
Children's Memorial Hermann Hospital, Houston, TX.
7
Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH.
8
Department of Surgery, Arkansas Children's Hospital, St Louis, MO.
9
Department of Surgery, Children's Hospital of Alabama at UAB, Birmingham, AL.
10
Department of Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN.

Abstract

BACKGROUND:

Computed tomography is commonly used to rule out intra-abdominal injury (IAI) in children, despite associated cost and radiation exposure. Our purpose was to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be unnecessary.

STUDY DESIGN:

We prospectively enrolled children younger than 16 years of age who presented after BAT at 14 Level I pediatric trauma centers during 1 year. We excluded patients who presented more than 6 hours after injury or underwent abdominal CT before transfer. We used binary recursive partitioning to derive a prediction rule identifying children at very low risk of IAI and IAI requiring acute intervention (IAI-I) using clinical information available in the trauma bay.

RESULTS:

We included 2,188 children with a median age of 8 years. There were 261 patients with IAI (11.9%) and 62 patients with IAI-I (2.8%). The prediction rule consisted of (in descending order of significance): aspartate aminotransferase >200 U/L, abnormal abdominal examination, abnormal chest x-ray, report of abdominal pain, and abnormal pancreatic enzymes. The rule had a negative predictive value of 99.4% for IAI and 100.0% for IAI-I in patients with none of the prediction rule variables present. The very-low-risk population consisted of 34% of the patients and 23% received a CT scan. Computed tomography frequency ranged from 4% to 96% by center.

CONCLUSIONS:

A prediction rule using history and physical examination, chest x-ray, and laboratory evaluation at the time of presentation after BAT identifies children at very low risk for IAI for whom CT can be avoided.

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[Indexed for MEDLINE]

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