Emergency Medicine Book

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Pediatric Blunt Abdominal Trauma Decision Rule

Aka: Pediatric Blunt Abdominal Trauma Decision Rule, Blunt Abdominal Trauma Decision Rule for Children
  1. See Also
    1. Pediatric Blunt Abdominal Trauma
    2. Pediatric Trauma
    3. Abdominal Trauma
  2. Indications
    1. Pediatric Blunt Abdominal Trauma
  3. Criteria
    1. Abdominal wall Trauma signs or seatbelt sign
    2. Glasgow Coma Scale <14
    3. Abdominal tenderness on exam
    4. Thoracic wall Trauma
    5. Complains of Abdominal Pain
    6. Absent or decreased breath sounds
    7. Vomiting
  4. Interpretation
    1. All 7 criteria negative
      1. Very reassuring and unlikely to have intra-Abdominal Injury requiring intervention
      2. CT Abdomen not indicated unless for other criteria
    2. Any criteria positive
      1. Does not exclude significant intraabdominal injury
      2. Further evaluation required (e.g. imaging)
  5. Efficacy
    1. Based on prospective study with over 12,000 patients, of whom 1.3% had a significant Abdominal Injury requiring intervention
      1. Study did not incorporate FAST Exam or labs in the decision rule (due to lack of standardization across study centers)
    2. Efficacy in identifying intraabdominal injury
      1. Test Sensitivity: 97% (higher than gestalt, which was 82.8%)
      2. Test Specificity: 42.5% (lower than gestalt, which was 78.7%)
      3. Negative Predictive Value: 99.9%
      4. Borgialli (2014) Acad Emerg Med 21: 1240-8 [PubMed]
  6. References
    1. Holmes (2013) Ann Emerg Med 62(2):107-16 +PMID:23375510 [PubMed]

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