Clinical question Does a scoring system using clinical, laboratory, and radiographic criteria reliably predict the absence of organ injury in children with blunt abdominal trauma?

Bottom line This unvalidated scoring system, which includes clinical, laboratory, and ultrasound results, is fairly sensitive in identifying children with blunt abdominal trauma who are unlikely to have organ injury. (Level of evidence = 2b)

Synopsis Consecutive children suffering from blunt abdominal trauma underwent a standard work-up consisting of blood and urine tests and abdominal ultrasound. The children who did not have normal (or nearly normal) test results or an abnormal ultrasound underwent a contrast CT of the abdomen. All patients were admitted to the hospital, either for treatment or for observation for at least 24 hours. Children who were doing well were sent home, those with persistent pain had a CT if they hadn't had one in the emergency department. A pediatric radiologist interpreted all ultrasound and CT images, although the authors do not report if the radiologist was aware of any of the other clinical data. The diagnosis of organ injury was based on the presence of abnormal CT findings. The absence of injury was based on a normal CT. For children who did not have a CT because their initial workup was normal, the absence of injury was based on whether they were pain free at 24 hours. The authors played a variety of statistical games to identify factors in children unlikely to have organ injury. They developed a scoring system and used receiver operating characteristic curves to identify cutoff points for the scoring system. Thirty children had organ injury and 116 did not. To use the score, assign 4 points for abnormal ultrasound; 2 points for each of the following: abdominal pain, peritoneal irritation, hemodynamic instability, AST above 60 IU/L, ALT above 25 IU/L; 1 point for each of the following: WBC count more than 9.5 grams/L, LDH higher than 330 IU/L, lipase higher than 30 IU/L, creatinine higher than 50 g/L. A score of 7 or less was 91% sensitive and 84% specific (positive likelihood ratio = 5.7; negative likelihood ratio = 0.11). In other words, when the score was 7 or less, the child was unlikely to have organ injury. This score needs to be independently validated.

Karam O, Sanchez O, Chardot C, La Scala G. Blunt abdominal trauma in children: a score to predict the absence of organ injury. J Pediatr. 2009;154(6):912-917.

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