Karam et al reported the Blunt Abdominal Trauma in Children (BATiC) score for evaluating children who have had blunt abdominal trauma. This can help to identify a patient at risk for intra-abdominal injury. The authors are from University of Geneva Children's Hospital.
Patient selection: pediatric patient with blunt abdominal trauma, age range not specified
Parameters:
(1) abdominal Doppler ultrasound exam
(2) abdominal pain
(3) signs of peritoneal irritation
(4) hemodynamic instablity
(5) serum AST concentration in IU/L
(6) serum ALT concentration in IU/L
(7) WBC count
(8) serum LDH concentration in IU/L
(9) serum lipase concentration in IU/L
(10) serum creatinine concentration in µmol/L
|
Parameter
|
Finding
|
Points
|
|
abdominal Doppler ultrasound exam
|
normal
|
0
|
|
|
abnormal
|
4
|
|
abdominal pain
|
absent
|
0
|
|
|
present
|
2
|
|
signs of peritoneal irritation
|
absent
|
0
|
|
|
present
|
2
|
|
hemodynamic instability
|
absent
|
0
|
|
|
present
|
2
|
|
serum AST
|
<= 60 IU/L
|
0
|
|
|
> 60 IU/L
|
2
|
|
serum ALT
|
<= 25 IU/L
|
0
|
|
|
> 25 IU/L
|
2
|
|
WBC count
|
<= 9.5*10^9/L
|
0
|
|
|
> 9.5 * 10^9/L
|
1
|
|
serum LDH
|
<= 330 IU/L
|
0
|
|
|
> 330 IU/L
|
1
|
|
serum lipase
|
<=30
|
0
|
|
|
> 30 IU/L
|
1
|
|
serum creatinine
|
<= 50 µmmol/L
|
0
|
|
|
> 50 µmmol/L
|
1
|
where:
• The original paper reports the WBC count in g/L.
total score =
= SUM(points for all 10 parameters)
Interpretation:
• minimum score: 0
• maximum score: 18
• The higher the score the greater the risk of intra-abdominal organ injury.
• A score <=7 had a negative predictive value of 97%.
• According to the box plot in the Figure a score <=4 has a very low risk of abdominal organ injury.
Performance:
• The serum chemistry cut-offs may be different based on different test methods.
• The area under the ROC is claimed to be 0.92 (sensitivity 91% and specificity 84%).
