Accuracy of the Abdominal Examination for Identifying Children with Blunt Intra-Abdominal Injuries - 21/11/14
, Nathan Kuppermann, MD, MPH 3, 4, Joshua Kooistra, DO 5, Madelyn Garcia, MD, MPH 6, David J. Monroe, MD 7, Prashant Mahajan, MD, MPH 8, Jay Menaker, MD 9, Peter Ehrlich, MD 10, Shireen Atabaki, MD, MPH 11, Kent Page, MStat 2, Maria Kwok, MD 12, James F. Holmes, MD, MPH 3on behalf of the
Intra-Abdominal Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN)∗
Abstract |
Objective |
To determine the accuracy of complaints of abdominal pain and findings of abdominal tenderness for identifying children with intra-abdominal injury (IAI) stratified by Glasgow Coma Scale (GCS) score.
Study design |
This was a prospective, multicenter observational study of children with blunt torso trauma and a GCS score ≥13. We calculated the sensitivity of abdominal findings for IAI with 95% CI stratified by GCS score. We examined the association of isolated abdominal pain or tenderness with IAI and that undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or ≥2 nights of intravenous fluid therapy).
Results |
Among the 12 044 patients evaluated, 11 277 (94%) had a GCS score of ≥13 and were included in this analysis. Sensitivity of abdominal pain for IAI was 79% (95% CI, 76%-83%) for patients with a GCS score of 15, 51% (95% CI, 37%-65%) for patients with a GCS score of 14, and 32% (95% CI, 14%-55%) for patients with a GCS score of 13. Sensitivity of abdominal tenderness for IAI also decreased with decreasing GCS score: 79% (95% CI, 75%-82%) for a GCS score of 15, 57% (95% CI, 42%-70%) for a GCS score of 14, and 37% (95% CI, 19%-58%) for a GCS score of 13. Among patients with isolated abdominal pain and/or tenderness, the rate of IAI was 8% (95% CI, 6%-9%) and the rate of IAI undergoing acute intervention was 1% (95% CI, 1%-2%).
Conclusion |
The sensitivity of abdominal findings for IAI decreases as GCS score decreases. Although abdominal computed tomography is not mandatory, the risk of IAI is sufficiently high that diagnostic evaluation is warranted in children with isolated abdominal pain or tenderness.
Le texte complet de cet article est disponible en PDF.Keyword : CT, ED, GCS, IAI, IAIAI, PECARN
Plan
| Supported by the Centers for Disease Control and Injury Prevention (1 R49CE00100201). PECARN is supported by the Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children Program (U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC00008, U03MC22684, and U03MC22685). The authors declare no conflicts of interest. |
Vol 165 - N° 6
P. 1230 - décembre 2014 Retour au numéro
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