Holmes et al identified clinical findings associated with intra-abdominal injuries in pediatric patients suffering blunt trauma to the torso. These can help identify patients who may benefit from closer evaluation of the abdomen. The authors are from University of California at Davis.


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.


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