Related Experiment Videos
Utility of routine laboratory testing for detecting intra-abdominal injury in the pediatric trauma patient
D J Isaacman1, R J Scarfone, S I Kost
1Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213-2583.
Insights
In moderately injured pediatric trauma patients, physical examination combined with urinalysis is a highly sensitive screen for intra-abdominal injury (IAI). Laboratory abnormalities are uncommon and rarely identify unsuspected IAI when physical exam and urinalysis are normal.
Area of Science:
- Pediatric Trauma Care
- Diagnostic Accuracy in Emergency Medicine
- Abdominal Injury Assessment
Background:
- Intra-abdominal injuries (IAI) are a concern in pediatric trauma.
- Accurate and efficient diagnostic methods are crucial for timely intervention.
- The role of laboratory abnormalities and physical examination in detecting IAI needs clarification.
Purpose of the Study:
- To determine the prevalence of laboratory abnormalities in moderately injured pediatric trauma patients.
- To evaluate the sensitivity and specificity of physical examination (PE) and screening laboratory tests for identifying IAI.
- To assess the utility of laboratory testing in conjunction with PE and urinalysis for IAI detection.
Main Methods:
- Retrospective chart review of 285 level II pediatric trauma patients.
- Systematic recording of PE findings, laboratory results, and identified injuries.
- Application of a diagnostic model (PE + urinalysis) to an additional 91 trauma patients with confirmed IAI.
Main Results:
- Overall prevalence of laboratory abnormalities was 5.7%.
- Physical examination combined with urinalysis demonstrated 100% sensitivity and 64% specificity for IAI detection.
- The PE + urinalysis model identified abnormalities in 97.8% of confirmed IAI cases in the validation cohort.
Conclusions:
- Moderately injured pediatric trauma patients exhibit a low prevalence of laboratory abnormalities.
- Physical examination combined with urinalysis serves as a highly sensitive screening tool for intra-abdominal injury.
- Routine laboratory testing is unlikely to detect unsuspected IAI in patients with a normal abdominal PE and urinalysis.
Objective:
To assess the prevalence of laboratory abnormalities (complete blood cell count, electrolytes, blood urea nitrogen, creatinine, glucose, aspartate aminotransferase, alanine aminotransferase, amylase, lipase, urinalysis [U/A]) and the sensitivity and specificity of the physical examination (PE) and screening laboratory tests for identifying intra-abdominal injury (IAI) in moderately injured pediatric patients.
Design, Participants, And Setting:
Phase I: Retrospective chart review of 285 consecutive level II (moderately injured) trauma patients seen at a children's hospital emergency department/pediatric trauma center. All patients were received directly from the scene and had the following data recorded: mechanism of injury, Glasgow coma score, trauma score, pediatric trauma score, systematically recorded PE findings, laboratory results, and injuries detected during hospitalization. Phase II: To confirm the sensitivity of the PE and U/A found in phase I, the model was applied to 91 additional trauma patients identified by International Classification of Diseases, 9th revision (ICD-9) codes as having IAI.
Intervention:
None.
Results:
Phase I: A total of 3939 tests were ordered for the 285 patients entered in phase I. Aspartate aminotransferase and alanine aminotransferase values were obtained in 59% of patients; glucose level was obtained in 78% of patients; complete blood cell count, U/A, and levels of electrolytes, blood urea nitrogen, creatinine, amylase, and lipase were obtained in more than 85% of patients. The overall prevalence of laboratory abnormalities was 5.7%. Fourteen patients (4.8%) were identified who had a total of 23 significant IAIs (9 pancreatic, 6 splenic, 5 renal, 3 hepatic). The PE combined with U/A showing more than five red blood cells per high-power field had a sensitivity of 100%, specificity of 64%, positive predictive value of 13%, and negative predictive value of 100% for the detection of IAI. The presence of laboratory abnormalities suggesting injury did not increase the sensitivity of the model and significantly decreased both specificity and positive predictive value. Phase II: The PE combined with U/A identified an abnormality in 89 (97.8%) of 91 cases (95% confidence interval = 94.8% to 100%).
Conclusions:
In the moderately injured pediatric trauma patient, (1) there is a low prevalence of laboratory abnormalities; (2) the PE combined with U/A is a highly sensitive screen for IAI; and (3) in patients with a normal PE of the abdomen and a normal U/A, laboratory testing seldom identifies unsuspected IAI.