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Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries
Kathleen M Adelgais1, Nathan Kuppermann2, Joshua Kooistra3
1Department of Pediatrics, University of Colorado Denver, Aurora, CO; Department of Pediatrics, University of Utah, Salt Lake City, UT.
Insights
In children with blunt torso trauma, abdominal pain and tenderness sensitivity for intra-abdominal injury (IAI) decreases with lower Glasgow Coma Scale (GCS) scores. Diagnostic evaluation is crucial for children with isolated abdominal symptoms, even without mandatory CT scans.
Area of Science:
- Pediatric surgery
- Trauma care
- Diagnostic accuracy
Background:
- Blunt torso trauma in children can lead to intra-abdominal injuries (IAI).
- Assessing abdominal pain and tenderness is crucial for diagnosing IAI.
- Glasgow Coma Scale (GCS) score may influence the reliability of these symptoms.
Purpose of the Study:
- To evaluate the accuracy of abdominal pain and tenderness in identifying IAI in children.
- To stratify this accuracy based on the patient's GCS score.
Main Methods:
- Prospective, multicenter observational study.
- Included children with blunt torso trauma and GCS score ≥13.
- Calculated sensitivity of abdominal findings for IAI, stratified by GCS score.
Main Results:
- Sensitivity of abdominal pain and tenderness for IAI decreased as GCS scores decreased.
- For GCS 15, sensitivity was ~79%; for GCS 14, it was ~51-57%; for GCS 13, it was ~32-37%.
- IAI rate was 8% in patients with isolated abdominal pain/tenderness, with 1% requiring acute intervention.
Conclusions:
- Abdominal findings' sensitivity for IAI diminishes with lower GCS scores.
- Children with isolated abdominal pain or tenderness warrant diagnostic evaluation due to a significant IAI risk.
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.
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