Physical examination as a reliable tool to predict intra-abdominal injuries in brain-injured children.
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.
Miller
Douglas
D
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.
Garza
Jennifer
J
Tuggle
David
D
Mantor
Cameron
C
Puffinbarger
Nikola
N
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