title: Physical examination as a reliable tool to predict intra-abdominal injuries in brain-injured children.
abstract: BACKGROUND
  Brain-injured children have been thought to have an unreliable abdominal examination. This study evaluates the reliability of physical examination in the prediction of intra-abdominal injury in brain-injured children.
  
  
  METHODS
  Pediatric patients with a traumatic brain injury or Glasgow Coma Scale (GCS) <15 and intra-abdominal organ injuries were selected. Admission data were reviewed, and findings were tabulated.
  
  
  RESULTS
  Fifty patients had an abnormal abdominal examination. Nineteen of 71 patients with head injury and intra-abdominal organ injuries required laparotomy. These 19 patients had abdominal tenderness, distention, abrasions, and/or a positive focused abdominal sonography for trauma (FAST) scan. Seven of 19 patients had a GCS of 3. Of the 12 patients requiring surgery with GSC 4 to 14, all patients had abnormal physical examinations.
  
  
  CONCLUSIONS
  Patients who required an operation presented with an abnormal examination and/or a positive FAST. These data suggest that examination and/or FAST may reliably identify patients with intra-abdominal organ injuries in need of an operation.
authors.affiliation: Department of Surgery, Section of Pediatric Surgery, The University of Oklahoma College of Medicine, 940 NE 13th St, Room 2403, Oklahoma City, OK 73104, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Miller
authors.forename: Jennifer
authors.initials: J
authors.lastname: Garza
authors.forename: David
authors.initials: D
authors.lastname: Tuggle
authors.forename: Cameron
authors.initials: C
authors.lastname: Mantor
authors.forename: Nikola
authors.initials: N
authors.lastname: Puffinbarger
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology; D001930:Brain Injuries / Q000453:epidemiology*; D002648:Child; D015897:Comorbidity; D015600:Glasgow Coma Scale; D006801:Humans; D010808:Physical Examination; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014463:Ultrasonography