title: Accuracy of the abdominal examination for identifying children with blunt intra-abdominal injuries.
abstract: OBJECTIVE
  To determine the accuracy of complaints of abdominal pain and findings of abdominal tenderness for identifying children with intra-abdominal injury (IAI) stratified by Glasgow Coma Scale (GCS) score.
  
  
  METHODS
  This was a prospective, multicenter observational study of children with blunt torso trauma and a GCS score ≥13. We calculated the sensitivity of abdominal findings for IAI with 95% CI stratified by GCS score. We examined the association of isolated abdominal pain or tenderness with IAI and that undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or ≥2 nights of intravenous fluid therapy).
  
  
  RESULTS
  Among the 12 044 patients evaluated, 11 277 (94%) had a GCS score of ≥13 and were included in this analysis. Sensitivity of abdominal pain for IAI was 79% (95% CI, 76%-83%) for patients with a GCS score of 15, 51% (95% CI, 37%-65%) for patients with a GCS score of 14, and 32% (95% CI, 14%-55%) for patients with a GCS score of 13. Sensitivity of abdominal tenderness for IAI also decreased with decreasing GCS score: 79% (95% CI, 75%-82%) for a GCS score of 15, 57% (95% CI, 42%-70%) for a GCS score of 14, and 37% (95% CI, 19%-58%) for a GCS score of 13. Among patients with isolated abdominal pain and/or tenderness, the rate of IAI was 8% (95% CI, 6%-9%) and the rate of IAI undergoing acute intervention was 1% (95% CI, 1%-2%).
  
  
  CONCLUSIONS
  The sensitivity of abdominal findings for IAI decreases as GCS score decreases. Although abdominal computed tomography is not mandatory, the risk of IAI is sufficiently high that diagnostic evaluation is warranted in children with isolated abdominal pain or tenderness.
authors.affiliation: Department of Pediatrics, University of Colorado Denver, Aurora, CO; Department of Pediatrics, University of Utah, Salt Lake City, UT. Electronic address: kathleen.adelgais@childrenscolorado.org.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Adelgais
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Davis, CA; Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.affiliation: Department of Emergency Medicine, Helen DeVos Children's Hospital, Grand Rapids, MI.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kooistra
authors.affiliation: Department of Emergency Medicine, University of Rochester, Rochester, NY.
authors.forename: Madelyn
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Department of Pediatrics, Howard County Hospital, Columbia, MD.
authors.forename: David J
authors.initials: DJ
authors.lastname: Monroe
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.affiliation: Department of Surgery, University of Maryland, Baltimore, MD.
authors.forename: Jay
authors.initials: J
authors.lastname: Menaker
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Peter
authors.initials: P
authors.lastname: Ehrlich
authors.affiliation: Department of Emergency Medicine, Children's National Medical Center, Washington, DC.
authors.forename: Shireen
authors.initials: S
authors.lastname: Atabaki
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors.forename: Kent
authors.initials: K
authors.lastname: Page
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Maria
authors.initials: M
authors.lastname: Kwok
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Davis, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D015746:Abdominal Pain / Q000209:etiology; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D004621:Embolization, Therapeutic; D005260:Female; D041981:Gastrointestinal Tract / Q000293:injuries; D015600:Glasgow Coma Scale; D006801:Humans; D007813:Laparotomy; D008099:Liver / Q000293:injuries; D008297:Male; D010808:Physical Examination; D011446:Prospective Studies; D013154:Spleen / Q000293:injuries; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000628:therapy