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

Abstract

To evaluate the initial workup and design a score that would allow ruling out significant intra-abdominal organ injuries following blunt abdominal traumas (BAT). Data were collected prospectively from 147 consecutive patients admitted for BAT in a tertiary care hospital, over a 30-month period. Statistical significance of various parameters (trauma mechanism, clinical examination, laboratory tests, and ultrasound findings) were analyzed in relation to intra-abdominal injuries. The 10 parameters with the best negative predictive values (NPV) were then used to build a score (BATiC). The following points were attributed for these items: abnormal abdominal Doppler ultrasound (4 points), abdominal pain (2 points), peritoneal irritation (2 points), hemodynamic instability (2 points), aspartate aminotransferase >60 IU/L (2 points), alanine aminotransferase >25 IU/L (2 points), white blood cell count >9.5 g/L (1 point), LDH >330 IU/L (1 point), lipase >30 IU/L (1 point), and creatinine >50 microg/L (1 point). A score of < or = 7 has a NPV of 97% and includes 67% of the studied population. These results suggest that in hemodynamically stable patients with a normal abdominal Doppler ultrasound and a BATiC score of < or = 7, intra-abdominal lesions are very unlikely, and systematic CT scan or hospital admission may be avoided.