Which Kids Need Abdominal CT in Trauma

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:

1. Low age-adjusted systolic blood pressure
2. Abdominal tenderness
3. Femur fracture
4. Increased AST >200 U/L or ALT >125 U/L
5. Microscopic hematuria (UA >5 RBCs/high powered field)
6. 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.

Spoon Feed
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!

Source/Another Spoonful
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).