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Physical examination as a reliable tool to predict intra-abdominal injuries in brain-injured children
Douglas Miller1, Jennifer Garza, David Tuggle
1Department of Surgery, Section of Pediatric Surgery, The University of Oklahoma College of Medicine, 940 NE 13th St, Room 2403, Oklahoma City, OK 73104, USA.
Insights
Physical examination and FAST scans can reliably detect intra-abdominal injuries in brain-injured children. Abnormal findings on examination or a positive FAST scan indicate the need for surgical intervention in these vulnerable patients.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Diagnostic Imaging
Background:
- Brain-injured children are often presumed to have unreliable abdominal examinations.
- This study investigates the accuracy of physical exams in diagnosing intra-abdominal injuries in this population.
Purpose of the Study:
- To evaluate the reliability of physical examination in predicting intra-abdominal injuries in pediatric patients with traumatic brain injury.
- To determine if clinical findings and imaging can guide surgical decisions.
Main Methods:
- Retrospective review of pediatric patients with traumatic brain injury (Glasgow Coma Scale <15) and intra-abdominal injuries.
- Tabulation of admission data, physical examination findings, and Focused Abdominal Sonography for Trauma (FAST) scan results.
Main Results:
- Nineteen of 71 brain-injured patients with intra-abdominal injuries required surgery.
- These patients commonly presented with abdominal tenderness, distention, abrasions, and/or positive FAST scans.
- Abnormal physical examinations were noted in all surgically treated patients, including those with Glasgow Coma Scale scores from 4 to 14.
Conclusions:
- An abnormal abdominal examination and/or a positive FAST scan are key indicators for surgical intervention.
- These diagnostic tools appear to reliably identify brain-injured children requiring surgery for intra-abdominal organ injuries.
Background:
Brain-injured children have been thought to have an unreliable abdominal examination. This study evaluates the reliability of physical examination in the prediction of intra-abdominal injury in brain-injured children.
Methods:
Pediatric patients with a traumatic brain injury or Glasgow Coma Scale (GCS) <15 and intra-abdominal organ injuries were selected. Admission data were reviewed, and findings were tabulated.
Results:
Fifty patients had an abnormal abdominal examination. Nineteen of 71 patients with head injury and intra-abdominal organ injuries required laparotomy. These 19 patients had abdominal tenderness, distention, abrasions, and/or a positive focused abdominal sonography for trauma (FAST) scan. Seven of 19 patients had a GCS of 3. Of the 12 patients requiring surgery with GSC 4 to 14, all patients had abnormal physical examinations.
Conclusions:
Patients who required an operation presented with an abnormal examination and/or a positive FAST. These data suggest that examination and/or FAST may reliably identify patients with intra-abdominal organ injuries in need of an operation.
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