On the Shoulders of Giants
Scan fewer kids...maybe
This was a validation study of a previously derived clinical prediction instrument for predicting intra-abdominal injury in children with blunt trauma. It consists of these 6 criteria:
- Low age-adjusted systolic blood pressure
- Abdominal tenderness
- Femur fracture
- Increased AST >200 U/L or ALT >125 U/L
- Microscopic hematuria (UA >5 RBCs/high powered field)
- Initial hematocrit level less than 30%
This rule predicted all but 8 children with intra-abdominal injury, with sensitivity 94.9%. But the authors state, "further refinement of this prediction rule in a large, multicenter cohort is necessary before widespread implementation." So take this single-center study with a grain of salt.
These 6 criteria may help when considering the imaging strategy for children with blunt abdominal trauma. Pediatric EM Morsels unpacks this study, the subsequent study, and more in this great post. Worth a read!
Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma.
Ann Emerg Med. 2009 Oct;54(4):528-33. doi: 10.1016/j.annemergmed.2009.01.019. Epub 2009 Feb 28.
This same group (PECARN) did a subsequent derivation of a different pediatric abdominal trauma rule.
Peer Reviewer Comments
Agree with this summary. Also, good to see that none of the missed injuries required any surgical intervention (aside from ex-lap that required no actual repair).