Validation of a Prediction Rule for the Identification of Children With Intra-abdominal Injuries After Blunt Torso Trauma

Validation and Refinement of a Prediction Rule to Identify Children at Low Risk for Acute Appendicitis

“…17, 21 22–23 Similar to prior studies, our goal was to identify patients at low risk for illness in order to reduce reliance on diagnostic imaging and to reduce inefficient care delivery. As our study confirms, CT is heavily relied upon to diagnose and manage children with acute abdominal pain.…”

Evaluation for intra-abdominal injury in children after blunt torso trauma

“…Up to 90% of these injuries are as a result of blunt trauma 1 . Evaluation of the acutely injured pediatric patient is challenging and is often limited by factors which include alteration in mental status and difficulty communicating with young children 4 . CT is readily available and highly sensitive and has, therefore, become the procedure of choice in the evaluation of injured children 5–6 .…”

“…The dramatic increase in the number of CT scans performed nationally coupled with increased awareness of the risks of radiation exposure has led to active efforts to reduce the utilization of CT scans in the work-up of patients following blunt abdominal trauma. Recent retrospective studies have evaluated multiple factors in an effort to generate prediction rules for IAI that could be applied to limit the use of CT scans in patients who have suffered blunt abdominal trauma, are hemodynamically stable, have normal mental status, and have a reliable physical examination 4, 11–13 .…”

Blunt abdominal trauma in children

“…Given these radiation risks, there are ongoing attempts to help clinicians risk stratify patients for IAI with clinical prediction rules [19,29]. In 2009 Holmes et al [29] prospectively validated their previously derived clinical prediction rule for the identification of children at very low risk for IAI after blunt torso trauma. This rule included six 'high-risk' variables, and the presence of any of the variables indicated that the child was not at low risk: low age-adjusted systolic blood pressure, abdominal tenderness, femur fracture, increased liver enzyme levels (serum AST > 200 IU/l or ALT > 125 IU/l), microscopic hematuria (urinalysis > 5 red blood cells/high power field), or initial hematocrit less than 30%.…”

“…Unfortunately, children who are initially evaluated with abdominal CTs at community hospitals frequently undergo repeat CT scans after transfer to pediatric trauma centers, further increasing their exposure to ionizing radiation [27 & ,28]. Given these radiation risks, there are ongoing attempts to help clinicians risk stratify patients for IAI with clinical prediction rules [19,29]. In 2009 Holmes et al [29] prospectively validated their previously derived clinical prediction rule for the identification of children at very low risk for IAI after blunt torso trauma.…”