title: Identification of blunt abdominal injuries in children.
abstract: BACKGROUND
  The use of computed tomography (CT) to screen for injuries in pediatric blunt abdominal trauma (BAT) is increasing, concurrent with increasing concern over long-term risk of radiation-associated malignancies. We proposed to determine features that could be identified in the early assessment of these patients, which can predict the likelihood of clinically important intra-abdominal injuries warranting imaging by CT. We further queried if these were discrepant from factors associated with the decision to obtain an abdominal CT.
  
  
  METHODS
  Data of patients admitted with BAT to one of two Level I pediatric trauma centers were reviewed retrospectively. Clinical, laboratory, radiographic, and epidemiologic data were collected. Logistic regression was used to determine associations between pre-CT findings and ultimate diagnoses of "notable" or "clinically important" intra-abdominal injuries. Similar analyses were performed to determine which findings were associated with actually receiving an abdominal CT scan.
  
  
  RESULTS
  Of 571 patients, 37% had a notable intra-abdominal injury and 18% a clinically important intra-abdominal injury. After adjusting for all covariates, hematuria (gross or microscopic), elevated serum alanine aminotransferase, and documentation of clinically concerning abdominal findings upon examination remained significant predictors (odds ratio (OR), 3.5; 95% confidence interval [CI], 1.8-6.8; OR, 10.9; 95% CI, 2.5-47, respectively) of a clinically important injury. Undergoing a CT head and the presence of hematuria were significantly associated with obtaining a CT of the abdomen (OR, 3.4; 95% CI, 1.5-7.7; OR, 2.9; 95% CI, 1.1-7.3, respectively), while concerning abdominal findings and decreased Glasgow Coma Scale (GCS) score were not.
  
  
  CONCLUSIONS
  Clinical variables may be used to predict intra-abdominal injuries after pediatric BAT that may warrant imaging with CT scanning. Combined with findings from similar studies, it may be possible to derive and validate a decision-making rule both sensitive and specific in predicting the need for abdominal CT scanning in these patients.
  
  
  METHODS
  Prognostic study, level III.
authors.affiliation: From the Division of Pediatric General Surgery (N.H.H., N.L.Y.) and Department of Diagnostic Imaging (P.S.), Dalhousie University, Halifax, Nova Scotia; and Department of Emergency Medicine (M.B., S.N.), Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
authors.forename: Nina H
authors.initials: NH
authors.lastname: Hynick
authors.forename: Maureen
authors.initials: M
authors.lastname: Brennan
authors.forename: Pierre
authors.initials: P
authors.lastname: Schmit
authors.forename: Steve
authors.initials: S
authors.lastname: Noseworthy
authors.forename: Natalie L
authors.initials: NL
authors.lastname: Yanchar
mesh_terms: D000005:Abdomen / Q000473:pathology; D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D000410:Alanine Transaminase