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Identification of children with intra-abdominal injuries after blunt trauma
James F Holmes1, Peter E Sokolove, William E Brant
1Division of Emergency Medicine, Department of Internal Medicine, University of California-Davis School of Medicine, Sacramento, CA 95817-2282, USA. jfholmes@ucdavis.edu
Insights
Laboratory tests significantly aid in identifying intra-abdominal injuries in children after blunt trauma, even when physical exam findings are considered. These findings improve diagnostic accuracy for pediatric blunt abdominal trauma.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Surgery
- Diagnostic Accuracy
Background:
- Blunt abdominal trauma in children poses diagnostic challenges.
- Accurate identification of intra-abdominal injuries is crucial for timely intervention.
- Physical examination alone may not be sufficient to rule out intra-abdominal injuries.
Purpose of the Study:
- To evaluate the utility of laboratory testing in conjunction with physical examination for diagnosing intra-abdominal injuries in pediatric blunt trauma patients.
- To identify specific physical and laboratory findings independently associated with intra-abdominal injuries.
Main Methods:
- Prospective observational study of children (<16 years) with blunt trauma at a Level I trauma center.
- Standardized physical examinations and laboratory tests were performed.
- Logistic regression and recursive partitioning analyses identified significant predictors of intra-abdominal injury.
Main Results:
- 10% of 1,095 children had intra-abdominal injuries.
- Key predictors included low systolic blood pressure, abdominal tenderness, elevated liver enzymes (AST/ALT), positive urinalysis (RBCs), and low hematocrit.
- Femur fracture was also noted but with a less significant association.
Conclusions:
- Laboratory testing provides significant value in identifying intra-abdominal injuries in children with blunt trauma, complementing physical examination findings.
- Specific laboratory markers, alongside clinical signs, enhance diagnostic precision for pediatric blunt abdominal trauma.
Study Objective:
We sought to determine the utility of laboratory testing after adjusting for physical examination findings in the identification of children with intra-abdominal injuries after blunt trauma.
Methods:
The study was a prospective observational series of children younger than 16 years old who sustained blunt trauma and were at risk for intra-abdominal injuries during a 2(1/2)-year period at an urban Level I trauma center. Patients were examined by faculty emergency physicians and underwent standardized laboratory testing. Clinical and laboratory findings were recorded on a standardized data sheet. Intra-abdominal injury was considered present if an injury was documented to the spleen, liver, pancreas, kidney, adrenal glands, or gastrointestinal tract. We performed multiple logistic regression and binary recursive partitioning analyses to identify which physical examination findings and laboratory variables were independently associated with intra-abdominal injury.
Results:
Of 1,095 enrolled patients, 107 (10%, 95% confidence interval [CI] 8% to 12%) had intra-abdominal injuries. The mean age was 8.4+/-4.8 years. From both analyses, we identified 6 findings associated with intra-abdominal injury: low systolic blood pressure (adjusted odds ratio [OR] 4.1; 95% CI 1.1 to 15.2), abdominal tenderness (adjusted OR 5.8; 95% CI 3.2 to 10.4), femur fracture (adjusted OR 1.3; 95% CI 0.5 to 3.7), serum aspartate aminotransferase concentration more than 200 U/L or serum alanine aminotransferase concentration more than 125 U/L (adjusted OR 17.4; 95% CI 9.4 to 32.1), urinalysis with more than 5 RBCs per high-powered field (adjusted OR 4.8; 95% CI 2.7 to 8.4), and an initial hematocrit of less than 30% (adjusted OR 2.6; 95% CI 0.9 to 7.5).
Conclusion:
After adjusting for physical examination findings, laboratory testing contributes significantly to the identification of children with intra-abdominal injuries after blunt trauma.