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Identifying children at very low risk of clinically important blunt abdominal injuries.

Abstract：

STUDY OBJECTIVE:We derive a prediction rule to identify children at very low risk for intra-abdominal injuries undergoing acute intervention and for whom computed tomography (CT) could be obviated. METHODS:We prospectively enrolled children with blunt torso trauma in 20 emergency departments. We used binary recursive partitioning to create a prediction rule to identify children at very low risk of intra-abdominal injuries undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid for ≥2 nights for pancreatic/gastrointestinal injuries). We considered only historical and physical examination variables with acceptable interrater reliability. RESULTS:We enrolled 12,044 children with a median age of 11.1 years (interquartile range 5.8, 15.1 years). Of the 761 (6.3%) children with intra-abdominal injuries, 203 (26.7%) received acute interventions. The prediction rule consisted of (in descending order of importance) no evidence of abdominal wall trauma or seat belt sign, Glasgow Coma Scale score greater than 13, no abdominal tenderness, no evidence of thoracic wall trauma, no complaints of abdominal pain, no decreased breath sounds, and no vomiting. The rule had a negative predictive value of 5,028 of 5,034 (99.9%; 95% confidence interval [CI] 99.7% to 100%), sensitivity of 197 of 203 (97%; 95% CI 94% to 99%), specificity of 5,028 of 11,841 (42.5%; 95% CI 41.6% to 43.4%), and negative likelihood ratio of 0.07 (95% CI 0.03 to 0.15). CONCLUSION:A prediction rule consisting of 7 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 undergoing acute intervention. These findings require external validation before implementation.

journal_name

Ann Emerg Med

journal_title

Annals of emergency medicine

authors

Holmes JF,Lillis K,Monroe D,Borgialli D,Kerrey BT,Mahajan P,Adelgais K,Ellison AM,Yen K,Atabaki S,Menaker J,Bonsu B,Quayle KS,Garcia M,Rogers A,Blumberg S,Lee L,Tunik M,Kooistra J,Kwok M,Cook LJ,Dean JM,Sokolo

doi

10.1016/j.annemergmed.2012.11.009

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

107-116.e2

issue

eissn

0196-0644

issn

1097-6760

pii

S0196-0644(12)01743-X

journal_volume

pub_type

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Identifying children at very low risk of clinically important blunt abdominal injuries.