Items used by the authors for the prediction rule om 2002:
(1) hypotension
(2) abdominal tenderness
(3) femur fracture
(4) microscopic urinalysis
(5) initial hematocrit
(6) elevated serum levels of liver enzymes (ALT > 125 U/L or AST > 200 U/L)
Predictors with relative risk >= 4 in a validation study (Holmes et al, 2009):
(1) elevated serum levels of liver enzymes
(2) hypotension
(3) microscopic hematuria (> 5 RBCs per high power field in the urine sediment)
Predictors with relative risk 2.0 to 2.6 in a validation study (Holmes et al, 2009):
(1) hematocrit on presentation < 30 percent
(2) abdominal tenderness
(3) Glasgow coma score <= 13
(4) seat belt sign
(5) pelvic fracture
Predictors with relative risk < 2 in a validation study:
(1) left costal margin injury
(2) right costal margin injury
(3) absence of femur fracture (RR 1.23; presence of femur fracture had RR 0.78)
In Table 2 on page 531of the validation study (Holmes et al, 2009), 6% of patients with a femur fracture had intra-abdominal injury vs 7% of patients without a femur fracture. The odds ratio in the original paper was only 1.3 with a femur fracture.
