TY - JOUR
T1 - Identifying children at very low risk of clinically important blunt abdominal injuries
AU - Holmes, James F.
AU - Lillis, Kathleen
AU - Monroe, David
AU - Borgialli, Dominic
AU - Kerrey, Benjamin T.
AU - Mahajan, Prashant
AU - Adelgais, Kathleen
AU - Ellison, Angela M.
AU - Yen, Kenneth
AU - Atabaki, Shireen
AU - Menaker, Jay
AU - Bonsu, Bema
AU - Quayle, Kimberly S.
AU - Garcia, Madelyn
AU - Rogers, Alexander
AU - Blumberg, Stephen
AU - Lee, Lois
AU - Tunik, Michael
AU - Kooistra, Joshua
AU - Kwok, Maria
AU - Cook, Lawrence J.
AU - Dean, J. Michael
AU - Sokolove, Peter E.
AU - Wisner, David H.
AU - Ehrlich, Peter
AU - Cooper, Arthur
AU - Dayan, Peter S.
AU - Wootton-Gorges, Sandra
AU - Kuppermann, Nathan
PY - 2013/8
Y1 - 2013/8
N2 - Study objective: We derive a prediction rule to identify children at very low risk for intra-abdominal injuries undergoing acute intervention and for whom computed tomography (CT) could be obviated. Methods: We prospectively enrolled children with blunt torso trauma in 20 emergency departments. We used binary recursive partitioning to create a prediction rule to identify children at very low risk of intra-abdominal injuries undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid for ≥2 nights for pancreatic/ gastrointestinal injuries). We considered only historical and physical examination variables with acceptable interrater reliability. Results: We enrolled 12,044 children with a median age of 11.1 years (interquartile range 5.8, 15.1 years). Of the 761 (6.3%) children with intra-abdominal injuries, 203 (26.7%) received acute interventions. The prediction rule consisted of (in descending order of importance) no evidence of abdominal wall trauma or seat belt sign, Glasgow Coma Scale score greater than 13, no abdominal tenderness, no evidence of thoracic wall trauma, no complaints of abdominal pain, no decreased breath sounds, and no vomiting. The rule had a negative predictive value of 5,028 of 5,034 (99.9%; 95% confidence interval [CI] 99.7% to 100%), sensitivity of 197 of 203 (97%; 95% CI 94% to 99%), specificity of 5,028 of 11,841 (42.5%; 95% CI 41.6% to 43.4%), and negative likelihood ratio of 0.07 (95% CI 0.03 to 0.15). Conclusion: A prediction rule consisting of 7 patient history and physical examination findings, and without laboratory or ultrasonographic information, identifies children with blunt torso trauma who are at very low risk for intra-abdominal injury undergoing acute intervention. These findings require external validation before implementation.
AB - Study objective: We derive a prediction rule to identify children at very low risk for intra-abdominal injuries undergoing acute intervention and for whom computed tomography (CT) could be obviated. Methods: We prospectively enrolled children with blunt torso trauma in 20 emergency departments. We used binary recursive partitioning to create a prediction rule to identify children at very low risk of intra-abdominal injuries undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid for ≥2 nights for pancreatic/ gastrointestinal injuries). We considered only historical and physical examination variables with acceptable interrater reliability. Results: We enrolled 12,044 children with a median age of 11.1 years (interquartile range 5.8, 15.1 years). Of the 761 (6.3%) children with intra-abdominal injuries, 203 (26.7%) received acute interventions. The prediction rule consisted of (in descending order of importance) no evidence of abdominal wall trauma or seat belt sign, Glasgow Coma Scale score greater than 13, no abdominal tenderness, no evidence of thoracic wall trauma, no complaints of abdominal pain, no decreased breath sounds, and no vomiting. The rule had a negative predictive value of 5,028 of 5,034 (99.9%; 95% confidence interval [CI] 99.7% to 100%), sensitivity of 197 of 203 (97%; 95% CI 94% to 99%), specificity of 5,028 of 11,841 (42.5%; 95% CI 41.6% to 43.4%), and negative likelihood ratio of 0.07 (95% CI 0.03 to 0.15). Conclusion: A prediction rule consisting of 7 patient history and physical examination findings, and without laboratory or ultrasonographic information, identifies children with blunt torso trauma who are at very low risk for intra-abdominal injury undergoing acute intervention. These findings require external validation before implementation.
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U2 - 10.1016/j.annemergmed.2012.11.009
DO - 10.1016/j.annemergmed.2012.11.009
M3 - Article
C2 - 23375510
AN - SCOPUS:84880573802
SN - 0196-0644
VL - 62
SP - 107-116.e2
JO - Annals of emergency medicine
JF - Annals of emergency medicine
IS - 2
ER -