Prediction Rule Can Obviate Abdominal CT Scans in Children
(HealthDay News) – Seven factors can accurately predict whether a child with blunt torso trauma is at very low risk of intra-abdominal injuries and can avoid undergoing computed tomography (CT), according to a study published online Feb. 4 in the Annals of Emergency Medicine.
James F. Holmes, MD, MPH, from the University of California Davis School of Medicine in Sacramento, and colleagues analyzed data from 12,044 children (median age, 11.1 years) seen in 20 emergency departments with blunt torso trauma to identify those at very low risk for intra-abdominal injuries undergoing acute intervention who could avoid CT.
The researchers found that 6.3% of children had intra-abdominal injuries, and of these, 26.7% underwent acute intervention. Seven factors correlated with a very low risk of intra-abdominal injuries, including no evidence of trauma to the abdomen or chest, a Glasgow Coma Scale score >13, no abdominal pain or tenderness, no decreased breath sounds, and no vomiting. The prediction rule had a negative predictive value of 99.9%, a sensitivity of 97%, a specificity of 42.5%, and a negative likelihood ratio of 0.07.
"A prediction rule consisting of seven patient history and physical examination findings, and without laboratory or ultrasonographic information, identifies children with blunt torso trauma who are at very low risk for intra-abdominal injury and undergoing acute intervention," Holmes and colleagues conclude. "These findings require external validation before implementation."