Holmes et al developed a clinical prediction rule for identifying an adult who is at low risk for significant abdominal injury following blunt trauma to the torso. The authors are from the University of California Los Angeles.
Parameters:
(1) Glasgow coma score (GCS)
(2) tenderness at the costal margin
(3) abdominal tenderness
(4) femoral fracture
(5) number of RBCs per high power field (hpf) in the urine sediment
(6) hematocrit at presentation
(7) chest X-ray findings
|
Parameter |
Finding |
Points |
|
Glasgow coma score |
14 or 15 |
0 |
|
|
<= 13 |
1 |
|
tenderness at the costal margin |
absent |
0 |
|
|
present |
1 |
|
abdominal tenderness |
absent |
0 |
|
|
present |
1 |
|
fracture of the femur |
absent |
0 |
|
|
present |
1 |
|
RBCs in the urine sediment |
< 25 per hpf |
0 |
|
|
>= 25 per hpf |
1 |
|
hematocrit |
>= 30% |
0 |
|
|
< 30% |
1 |
|
chest X-ray |
normal |
0 |
|
|
pneumothorax, rib fracture or other abnormality |
1 |
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• A patient with a score of 0 is at very low risk for any intra-abdominal injury. An abdominal CT scan is unlikely to benefit the patient.
• Hypotension on presentation (systolic blood pressure < 90 mm Hg) was an additional variable that can help to identify a patient with abdominal trauma requiring acute intervention.
Performance:
• The sensitivity was 96% but the specificity was 26% (false positives).
• The negative predictive value was 99%.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Gastroenterology
ICD-10: ,
