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Development and Internal Validation of a Predictive Model for Operative Management in Blunt Abdominal Trauma Using
Raúl Sampayo-Candia1, Carlos A Guzmán-Martín2,3, Miguel A Vázquez-Toledo4
1Departamento de Cirugía de Trauma, Hospital de Traumatología y Ortopedia Dr. y Gral. Rafael Moreno Valle, Servicios Públicos de Salud del Instituto Mexicano del Seguro Social Para el Bienestar (IMSS-BIENESTAR), Puebla 72573, Mexico.
Early trauma triage is improved by a new model using admission lactate, heart rate, leukocyte count, and FAST scan. This helps identify patients needing surgery before CT scans, enhancing emergency department (ED) care.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Diagnostic Accuracy
Background:
- Early identification of blunt abdominal trauma patients needing operative management (OM) is crucial.
- Initial physiological signs can be nonspecific, complicating triage decisions.
- Computed tomography (CT) is often used but may delay critical interventions.
Purpose of the Study:
- To develop and validate an admission-based prediction model for early emergency department (ED) triage of blunt abdominal trauma patients.
- To utilize routinely available physiological and biochemical parameters prior to CT.
- To improve the identification of patients requiring operative management.
Main Methods:
- Retrospective observational study of adult blunt abdominal trauma patients.
- Inclusion criteria: FAST and lactate testing at admission.
- Multivariable logistic regression model developed using lactate, heart rate, leukocyte count, and FAST positivity.
Main Results:
- Lactate demonstrated good discrimination for OM (AUC 0.815).
- The final logistic model showed an optimism-corrected AUC of 0.882.
- Admission lactate combined with FAST and physiologic measurements provides useful early-triage information.
Conclusions:
- A prediction model using admission lactate, FAST, and physiologic data can aid pre-CT triage.
- This model offers valuable information for early patient assessment in blunt abdominal trauma.
- External validation in larger cohorts is recommended to confirm findings.
