Blunt abdominal trauma in children: a score to predict the absence of organ injury

Introduction

Blunt abdominal traumas (BAT) are frequent and potentially life-threatening events in children. The aim of this study was to evaluate the initial workup, and to design a score that would allow ruling out significant intra-abdominal organ injuries.

Methods

Data were collected prospectively from 147 consecutive patients admitted for BAT in a tertiary-care hospital, over a 30-month period. The statistical significance of various parameters (trauma mechanism, clinical examination, laboratory tests and ultrasound findings) was analyzed in relation to intra-abdominal injuries. To fix the cutoff limits for the various laboratory tests, we used receiver operating characteristic (ROC) curves. The items with the highest negative predictive value (NPV) were then selected, and their respective relative risk was computed. This was then integrated in a score (named Blunt Abdominal Trauma in Children (BATiC)), which was tested on our population.

Results

Among the 31 parameters evaluated, 10 differed significantly between the two groups: abdominal pain, signs of peritoneal irritation, hemodynamic instability, white blood cell (WBC) count, lactate dehydrogenase (LDH), alanine aminotransferase (AST), aspartate aminotransferase (ALT), lipase, creatinine, and abdominal ultrasound. For the six laboratory examinations, cutoff limits were determined using the ROC curves: AST >60 IU/l, ALT >25 IU/l, LDH >330 IU/l, WBC count >9.5 g/l, lipase >30 IU/l, and creatinine >50 IU/l. Based on their respective relative risks for abdominal organ injury, the following points were attributed for these items: abnormal abdominal Doppler ultrasound (4), abdominal pain (2), peritoneal irritation (2), hemodynamic instability (2), AST >60 IU/l (2), ALT >25 IU/l (2), WBC count >9.5 g/l (1), LDH >330 IU/l (1), lipase >30 IU/l (1), creatinine >50 μg/l (1). A score ≤ 7 had a NPV of 97%, and included 67% of the studied population.

Conclusion

These results suggest that in hemodynamically stable patients with a normal abdominal Doppler ultrasound, and a BATiC score ≤ 7, intra-abdominal lesions are very unlikely, and systematic CT scan or hospital admission may be avoided.