title: Identifying children at very low risk of clinically important blunt abdominal injuries.
abstract: OBJECTIVE
  We derive a prediction rule to identify children at very low risk for intra-abdominal injuries undergoing acute intervention and for whom computed tomography (CT) could be obviated.
  
  
  METHODS
  We prospectively enrolled children with blunt torso trauma in 20 emergency departments. We used binary recursive partitioning to create a prediction rule to identify children at very low risk of intra-abdominal injuries undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion for abdominal hemorrhage, or intravenous fluid for ≥2 nights for pancreatic/gastrointestinal injuries). We considered only historical and physical examination variables with acceptable interrater reliability.
  
  
  RESULTS
  We enrolled 12,044 children with a median age of 11.1 years (interquartile range 5.8, 15.1 years). Of the 761 (6.3%) children with intra-abdominal injuries, 203 (26.7%) received acute interventions. The prediction rule consisted of (in descending order of importance) no evidence of abdominal wall trauma or seat belt sign, Glasgow Coma Scale score greater than 13, no abdominal tenderness, no evidence of thoracic wall trauma, no complaints of abdominal pain, no decreased breath sounds, and no vomiting. The rule had a negative predictive value of 5,028 of 5,034 (99.9%; 95% confidence interval [CI] 99.7% to 100%), sensitivity of 197 of 203 (97%; 95% CI 94% to 99%), specificity of 5,028 of 11,841 (42.5%; 95% CI 41.6% to 43.4%), and negative likelihood ratio of 0.07 (95% CI 0.03 to 0.15).
  
  
  CONCLUSIONS
  A prediction rule consisting of 7 patient history and physical examination findings, and without laboratory or ultrasonographic information, identifies children with blunt torso trauma who are at very low risk for intra-abdominal injury undergoing acute intervention. These findings require external validation before implementation.
authors: Department Emergency Medicine, UC Davis School of Medicine, Sacramento, CA, USA. jfholmes@ucdavis.edu
authors: James F
authors: JF
authors: Holmes
authors: Kathleen
authors: K
authors: Lillis
authors: David
authors: D
authors: Monroe
authors: Dominic
authors: D
authors: Borgialli
authors: Benjamin T
authors: BT
authors: Kerrey
authors: Prashant
authors: P
authors: Mahajan
authors: Kathleen
authors: K
authors: Adelgais
authors: Angela M
authors: AM
authors: Ellison
authors: Kenneth
authors: K
authors: Yen
authors: Shireen
authors: S
authors: Atabaki
authors: Jay
authors: J
authors: Menaker
authors: Bema
authors: B
authors: Bonsu
authors: Kimberly S
authors: KS
authors: Quayle
authors: Madelyn
authors: M
authors: Garcia
authors: Alexander
authors: A
authors: Rogers
authors: Stephen
authors: S
authors: Blumberg
authors: Lois
authors: L
authors: Lee
authors: Michael
authors: M
authors: Tunik
authors: Joshua
authors: J
authors: Kooistra
authors: Maria
authors: M
authors: Kwok
authors: Lawrence J
authors: LJ
authors: Cook
authors: J Michael
authors: JM
authors: Dean
authors: Peter E
authors: PE
authors: Sokolove
authors: David H
authors: DH
authors: Wisner
authors: Peter
authors: P
authors: Ehrlich
authors: Arthur
authors: A
authors: Cooper
authors: Peter S
authors: PS
authors: Dayan
authors: Sandra
authors: S
authors: Wootton-Gorges
authors: Nathan
authors: N
authors: Kuppermann
mesh_terms: D001064:Appendicitis / Q000175:diagnosis*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male