Validation of a Noninvasive Score for Predicting Pediatric Intra-Abdominal Injuries

Authors: de Jong W-JJ et al., J Trauma Acute Care Surg 2014 May 76:1282

A Blunt Abdominal Trauma in Children score of greater than 6 had a sensitivity of 100% and specificity of 87% for intra-abdominal injury.

Investigators retrospectively validated the Blunt Abdominal Trauma in Children (BATiC) score in children less than 18 years of age presenting to a hospital in the Netherlands with blunt abdominal trauma between 2006 and 2011 (NEJM JW Emerg Med Jul 17 2009). Patients were included in the analysis if at least 6 of the 10 BATiC variables were available.

Points for the BATiC score were assigned as follows:

·4 points for abnormal abdominal ultrasound findings (free fluid, or injury to hollow or visceral organs)

·2 points each for abdominal pain, peritoneal irritation on physical exam, hemodynamic instability, aspartate aminotransferase greater than 60 IU/L, and alanine aminotransferase greater than 25 IU/L

·1 point each for white blood cell count >10 × 109/L, lactate dehydrogenase greater than 330 IU/L, amylase greater than 10 IU/L, and creatinine greater than 110 µmol/L

Of 216 patients (median age, 12 years), 18 (8%) had intra-abdominal injuries and 7 required surgical intervention. A BATiC score cut-off of greater than 6 (out of a possible score of 18) resulted in a sensitivity of 100% and specificity of 87% for intra-abdominal injury. A cut-off of 7 resulted in a sensitivity of 89% and a specificity of 94%. Using cut-offs of 6 and 7 could have avoided 47% and 56%, respectively, of the 34 computed tomography scans performed.

Comment

Although these results are promising, data for many BATiC variables were missing in the analysis. It is reasonable to use this score to help guide clinical decision making, but clinician judgment should override the score when there are concerning findings. Prospective validation is needed before the score is widely adopted.