Identification of intra-abdominal injuries in children hospitalized following blunt torso trauma

Objective: To determine the utility of the ED physical examination and labo ratory analysis in screening hospitalized pediatric blunt trauma patients f or intra-abdominal injuries (IAIs). Methods: The authors reviewed the recor ds of all patients aged <15 years who sustained blunt traumatic injury and were admitted to a Level 1 trauma center over a four-year period. Patients were considered high-risk for IAI if they had any of the following at ED pr esentation: decreased level of consciousness (GCS < 15), abdominal pain, te nderness on abdominal examination, or gross hematuria. Patients without any of these findings were considered moderate risk for IAI. The authors compa red moderate-risk patients with and without IAIs with regard to physical ex amination and laboratory findings obtained in the ED. Results: Of 1,040 chi ldren with blunt trauma, 559 (54%) were high-risk and 481 (46%) were modera te-risk for LAI. 126 (23%) of the high-risk and 22 (4.6%) of the moderate-r isk patients had Ws. Among moderate-risk patients with and without Ws, thos e with IAIs were more likely to have abdominal abrasions (5/22 vs 34/459, p = 0.008), an abnormal chest examination (11/22 vs 86/457, p = 0.01), highe r mean serum concentrations of aspartate aminotransferase (AST) (604 U/L vs 77 U/L, p < 0.001) and alanine aminotransferase (ALT) (276 U/L vs 39 U/L, p = 0.002), higher mean white blood cell (WBC) counts (16.3 K/mm(3) vs 12.8 K/mm(3), p < 0.001), and a higher prevalence of >5 RBCs/hpf on urinalysis (7/22 vs 54/427, p = 0.02). There was no significant difference (p > 0.05) between moderate-risk patients with and without IAIs in initial serum conce ntrations of amylase, initial hematocrit, drop in hematocrit >5 percentage points in the ED, or initial serum bicarbonate concentrations. Conclusion: In children hospitalized for blunt torso trauma who are at moderate risk fo r IAI, ED findings of abdominal abrasions, an abnormal chest examination, a nd microscopic hematuria as well as elevated levels of AST and ALT, and ele vated WBC count are associated with IAI.