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Enhancing clinical risk assessment in pediatric blunt abdominal trauma: A novel scoring system using ultrasound and
Mehdi Nasr Isfahani1,2, Elahe Nasri Nasrabadi1, Zahra Rabiei3
1Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Insights
A new scoring system using ultrasound, physical exam, and lab tests helps diagnose intra-abdominal injury (IAI) in children with blunt abdominal trauma (BAT). This approach reduces the need for CT scans, minimizing radiation exposure in pediatric patients.
Area of Science:
- Pediatric Traumatology
- Diagnostic Imaging
- Emergency Medicine
Background:
- Accurate diagnosis of intra-abdominal injury (IAI) is crucial in pediatric blunt abdominal trauma (BAT).
- Minimizing radiation exposure from CT scans in children is a significant concern in trauma care.
Purpose of the Study:
- To develop and evaluate a scoring criterion for assessing the clinical risk of IAI in children with BAT.
- To utilize ultrasound (US) findings and laboratory data to improve diagnostic accuracy and reduce reliance on CT scans.
Main Methods:
- Retrospective analysis of 180 children (under 18) with BAT.
- Inclusion of physical examination, hemodynamic parameters, and laboratory data (WBC count, hematuria).
- Assessment of IAI through medical records and follow-up, utilizing US findings, abdominal tenderness, WBC count, and hematuria.
Main Results:
- A scoring system combining US findings, abdominal tenderness, hematuria, and high WBC levels demonstrated significant diagnostic value (P < 0.001).
- A cutoff score of ≥2 predicted IAI with 81.48% sensitivity and 94.12% specificity (AUC = 0.94).
- Individual parameters showed varying sensitivities and specificities, with positive US findings (92.59% sensitivity) and abdominal tenderness (87.58% specificity) being notable.
Conclusions:
- A scoring system integrating US, physical exam, and lab results effectively diagnoses IAI in pediatric BAT.
- A score of 2 or more strongly indicates IAI, aiding clinical decision-making for further imaging and treatment.
- Implementation of this scoring system can reduce unnecessary CT scans and radiation exposure in pediatric trauma care.
Background:
Given the importance of diagnosing intra-abdominal injury (IAI) in children with blunt abdominal trauma (BAT) and preventing radiation exposure to children by avoiding CT scans, this study aimed to evaluate a scoring criterion based on ultrasound (US) findings and laboratory data in assessing the clinical risk of IAI in children with BAT.
Materials And Methods:
In this retrospective study, baseline and clinical information of 180 children (under 18 years of age) with BAT including physical examination, hemodynamic parameters, and laboratory data, were extracted from medical records. US findings were considered abnormal if any report of mild free fluid or solid organ injury was noted. The presence or absence of IAI was assessed through medical records or telephone interviews to inquire about the patients' outcome within the two-week period post-discharge. The primary outcome was the identification of IAI, assessed through a combination of US findings, physical examination (abdominal tenderness), and laboratory parameters (WBC count and hematuria). The measurement methods included Chi-squared tests, Fisher's exact test, independent samples t-test, logistic regression, and ROC analysis.
Results:
The current study showed that 153 (85%) and 27 (15%) patients were without and with IAI, respectively. The positive US finding with sensitivity and specificity of 92.59% and 44.44%, respectively, abdominal tenderness with sensitivity and specificity of 81.48% and 87.58%, respectively, hematuria with sensitivity and specificity of 62.96% and 50.33%, respectively, and high WBC level with sensitivity and specificity of 85.19% and 76.47%, had a significant diagnostic value in detecting the presence of IAI (P value < 0.001). A cutoff point ≥ 2 from the sum of the scores of these four criteria can predict the presence of IAI with a sensitivity of 81.48% and a specificity of 94.12% (AUC = 0.94; P value < 0.001).
Conclusion:
This study shows that a scoring system based on positive US findings, abdominal tenderness, hematuria, and high WBC levels effectively diagnoses IAI in BAT children. A score of 2 or more strongly indicates the presence of IAI, improving decision-making for further imaging and treatment. Implementing this system can reduce unnecessary CT scans and radiation exposure, enhancing pediatric trauma care.
