Hughes et al reported a rule for identifying a pediatric patient at very low risk of intra-abdominal injury after blunt trauma. The authors are form multiple institutions participating in the Pediatric Emergency Care Applied Research Network (PECARN).
Patient selection: pediatric patient with blunt abdominal trauma
Parameters:
(1) Glasgow coma score (GCS)
(2) evidence of thoracic wall trauma (erythema, abrasions, ecchymosis, laceration, subcutaneous air)
(3) abdominal tenderness
(4) evidence of abdominal wall trauma or seat beat sign (erythema, abrasions, ecchymosis, laceration, subcutaneous air)
(5) complaints of abdominal pain
(6) decreased breath sounds
(7) history of vomiting after the injury
|
Parameter
|
Finding
|
Points
|
|
Glasgow coma score
|
14 or 15
|
0
|
|
|
<= 13
|
1
|
|
thoracic wall trauma
|
absent
|
0
|
|
|
present
|
1
|
|
abdominal tenderness
|
absent
|
0
|
|
|
present
|
1
|
|
abdominal wall trauma or seat belt sign
|
absent
|
0
|
|
|
present
|
1
|
|
abdominal pain
|
absent
|
0
|
|
|
present
|
1
|
|
decreased breath sounds
|
absent
|
0
|
|
|
present
|
1
|
|
history of vomiting
|
absent
|
0
|
|
|
present
|
1
|
total score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• If the score is 0, then the chances of intra-abdominal injury are very low.
• The negative predictive value is 99.9%.
• An abdominal CT scan can be deferred if the score is 0.
