Document Detail


Evaluation for intra-abdominal injury in children after blunt torso trauma: can we reduce unnecessary abdominal computed tomography by utilizing a clinical prediction model?
MedLine Citation:
PMID:  22846942     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Blunt trauma is a leading cause of morbidity and mortality in children. Despite the potential for malignancy, increased cost, limited small bowel injury detection sensitivity, and the low incidence of injury requiring operative intervention, the use of computed tomographic (CT) scan in pediatric blunt trauma evaluation remains common. Previous studies suggest that a clinical model using examination and laboratory data may help predict intra-abdominal injuries (IAIs) and potentially limit unnecessary CT scans in children.
METHODS: A retrospective chart review of all blunt "trauma alerts" for patients younger than 16 years during an 18-month period was performed at a Level I trauma center. Clinical factors, which might predict blunt IAI (hemodynamics, abdominal examination, serology, and plain radiographs), and potential limitations to performing a reliable abdominal examination (altered mental status, young age) were reviewed. A previously defined clinical prediction model based on six high-risk clinical variables for blunt IAI (hypotension, abnormal abdominal examination, elevated aspartate aminotransferase, elevated amylase, low hematocrit, and heme-positive urinalysis) was applied to each patient.
RESULTS: Of the 125 "trauma alert" patients who sustained blunt trauma during the study period, 97 underwent abdominal CT scan, with only 15 identified as IAI. Our prediction rule would have identified 16 of 17 patients with IAI (SE, 94%) as high-risk and missed only 1 patient (grade I spleen laceration, which did not require operation) (negative predictive value, 99%). Of the 83 patients with no risk factors for IAI based on the prediction rule, 54 underwent a negative abdominal CT scan. Of these 54 patients, only 22 had a potential limitation to a reliable abdominal examination. Application of our prediction rule could have prevented unnecessary CT scan in at least 32 patients (33%) during an 18-month period.
CONCLUSION: Use of a prediction model based on high-risk variables for IAI may decrease cost and radiation exposure by reducing the number of abdominal CT scans in children being evaluated for blunt abdominal trauma.
Authors:
Christian J Streck; Brent M Jewett; Amy H Wahlquist; Peter S Gutierrez; W Scott Russell
Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  73     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-31     Completed Date:  2012-10-18     Revised Date:  2013-12-12    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  371-6; discussion 376     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Abdominal Injuries / diagnosis,  radiography*
Adolescent
Child
Child, Preschool
Cohort Studies
Confidence Intervals
Cost Savings
Female
Humans
Injury Severity Score
Length of Stay
Male
Multiple Trauma / diagnosis,  radiography
Odds Ratio
Predictive Value of Tests
Radiation Injuries / prevention & control
Retrospective Studies
Risk Assessment
Thoracic Injuries / diagnosis,  radiography*
Tomography, X-Ray Computed / economics,  utilization*
Trauma Centers
Unnecessary Procedures*
Wounds, Nonpenetrating / diagnosis,  radiography*
Grant Support
ID/Acronym/Agency:
UL1 RR029882/RR/NCRR NIH HHS; UL1RR029882/RR/NCRR NIH HHS
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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