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Rule Predicts Children's Risk for Injury after Blunt Torso Trauma Without CT
By Cara Adler
A decision rule based on history and physical findings can identify children with blunt torso trauma at very low risk for intra-abdominal injuries needing interventions, according to an Annals of Emergency Medicine study.
To develop the rule, researchers prospectively studied some 12,000 children at 20 emergency departments who suffered blunt torso trauma. Abdominal CT scans were obtained for 46% of patients and identified intra-abdominal injuries in roughly 760. Some 200 patients with injuries underwent acute interventions including therapeutic laparotomy, angiographic embolization, and blood transfusion.
A rule consisting of 7 variables — Glasgow Coma Scale score >13, no abdominal tenderness, no evidence of abdominal wall trauma or seat belt sign, no evidence of thoracic wall trauma, no complaints of abdominal pain, no decreased breath sounds, and no vomiting — had a predictive value of 99.9% for identifying patients who would not need acute interventions.
The authors conclude that "if externally validated, this rule could aid clinicians in lowering abdominal CT use in children."
Annals of Emergency Medicine article (Free PDF)
Published in Physician's First Watch February 4, 2013
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