title: External validation of the Blunt Abdominal Trauma in Children (BATiC) score: ruling out significant abdominal injury in children.
abstract: BACKGROUND
  The aim of this study was to validate the use of the Blunt Abdominal Trauma in Children (BATiC) score. The BATiC score uses only readily available laboratory parameters, ultrasound results, and results from physical examination and does therefore not carry any risk of additional radiation exposure.
  
  
  METHODS
  Data of pediatric trauma patients admitted to the shock room between 2006 and 2010 were retrospectively analyzed. Blunt abdominal trauma was defined radiologically or surgically. The BATiC score was computed using 10 parameters as follows: abnormal abdominal ultrasound finding, abdominal pain, peritoneal irritation, hemodynamic instability, aspartate aminotransferase greater than 60 U/L, alanine aminotransferase greater than 25 U/L, white blood cell count greater than 10 × 10/L, lactate dehydrogenase greater than 330 U/L, amylase greater than 100 U/L, and creatinine greater than 110 μmol/L. Sensitivity, specificity, negative predictive value, and positive predictive value were computed. Missing values were replaced using multiple imputation, and BATiC scores were calculated based on imputed values.
  
  
  RESULTS
  Included were 216 patients, with 144 males, 72 females, and a median age of 12 years. Eighteen patients (8%) sustained abdominal injury. Median BATiC scores of patients with and without intra-abdominal injury were 9.2 (range, 6.6-15.4) and 2.2 (range, 0.0-10.6) respectively (p < 0.001). When the BATiC score is used with a cutoff point of 6, the test showed a sensitivity of 100% and a specificity of 87%. Negative and positive predictive values were 100% and 41% respectively. The area under the curve was 0.98.
  
  
  CONCLUSIONS
  The BATiC score can be a useful adjunct in the assessment of the presence of abdominal trauma in children and can help determine which patients might benefit from a computed tomographic scan and/or further treatment and which might not.
  
  
  METHODS
  Prognostic study, level II.
authors.affiliation: From the Departments of Traumatology (W.-J.J.D.J., D.R.N., M.E.M.), Pediatric Surgery (L.S., J.B.H.), and Epidemiology (H.G.) University Medical Center Groningen (UMCG), Groningen, the Netherlands.
authors.forename: Willem-Jan J
authors.initials: WJ
authors.lastname: de Jong
authors.forename: Leon
authors.initials: L
authors.lastname: Stoepker
authors.forename: David R
authors.initials: DR
authors.lastname: Nellensteijn
authors.forename: Henk
authors.initials: H
authors.lastname: Groen
authors.forename: Mostafa
authors.initials: M
authors.lastname: El Moumni
authors.forename: Jan B
authors.initials: JB
authors.lastname: Hulscher
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology; D000293:Adolescent; D001774:Blood Chemical Analysis; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D009426:Netherlands; D010808:Physical Examination / Q000379:methods / Q000592:standards; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000379:methods*; D018608:Ultrasonography, Doppler / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000453:epidemiology