title: Identifying Children at Very Low Risk for Blunt Intra-Abdominal Injury in Whom CT of the Abdomen Can Be Avoided Safely.
abstract: BACKGROUND
  Computed tomography is commonly used to rule out intra-abdominal injury (IAI) in children, despite associated cost and radiation exposure. Our purpose was to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be unnecessary.
  
  
  METHODS
  We prospectively enrolled children younger than 16 years of age who presented after BAT at 14 Level I pediatric trauma centers during 1 year. We excluded patients who presented more than 6 hours after injury or underwent abdominal CT before transfer. We used binary recursive partitioning to derive a prediction rule identifying children at very low risk of IAI and IAI requiring acute intervention (IAI-I) using clinical information available in the trauma bay.
  
  
  RESULTS
  We included 2,188 children with a median age of 8 years. There were 261 patients with IAI (11.9%) and 62 patients with IAI-I (2.8%). The prediction rule consisted of (in descending order of significance): aspartate aminotransferase >200 U/L, abnormal abdominal examination, abnormal chest x-ray, report of abdominal pain, and abnormal pancreatic enzymes. The rule had a negative predictive value of 99.4% for IAI and 100.0% for IAI-I in patients with none of the prediction rule variables present. The very-low-risk population consisted of 34% of the patients and 23% received a CT scan. Computed tomography frequency ranged from 4% to 96% by center.
  
  
  CONCLUSIONS
  A prediction rule using history and physical examination, chest x-ray, and laboratory evaluation at the time of presentation after BAT identifies children at very low risk for IAI for whom CT can be avoided.
authors.affiliation: Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, SC. Electronic address: streck@musc.edu.
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Streck
authors.affiliation: Department of Surgery, St Louis Children's Hospital, St Louis, MO.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Vogel
authors.affiliation: Department of Surgery, Medical University of South Carolina Children's Hospital, Charleston, SC.
authors.forename: Jingwen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Le Bonheur Children's Hospital, Memphis, TN.
authors.forename: Eunice Y
authors.initials: EY
authors.lastname: Huang
authors.affiliation: Department of Surgery, Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Santore
authors.affiliation: Children's Memorial Hermann Hospital, Houston, TX.
authors.forename: Kuojen
authors.initials: K
authors.lastname: Tsao
authors.affiliation: Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Falcone
authors.affiliation: Department of Surgery, Arkansas Children's Hospital, St Louis, MO.
authors.forename: Melvin S
authors.initials: MS
authors.lastname: Dassinger
authors.affiliation: Department of Surgery, Children's Hospital of Alabama at UAB, Birmingham, AL.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Russell
authors.affiliation: Department of Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Blakely
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*