A Clinical Decision Rule to Guide Further Abdominal Imaging in Pediatric Blunt Abdominal Trauma
OUHSC, Oklahoma City, OK
A Clinical Decision Rule To Guide Further Abdominal Imaging in Pediatric Blunt Abdominal Trauma
Background: Our objective was to develop a clinical decision rule combining the FAST exam, physical and diagnostics findings to guide further abdominal imaging in pediatric blunt abdominal trauma in select patients.
Methods: Previous data determined the history, physical exam and cutoff laboratory results to be used in the final analysis, as well as the characteristics of the patients to be included. (Figure1) Our hypothesis was that if the patient fulfilled all set criteria then further imaging of the abdomen would not be necessary. To validate our criteria, we performed a retrospective chart review of all trauma patients aged 0-17 years evaluated at an academic American College of Surgeons (ACS) verified Level 1 Adult and Pediatric Trauma center between January 1, 2015 and December 31, 2015.
Findings: The FAST exam, combined with our clinical criteria for detecting intra-abdominal injuries in our selected patients, had a sensitivity of 86.2% (95%CI: 67.4%-95.5%), a specificity of 96.4% (95%CI: 79.7%-99.8%), a PPV of 96.2% (95%CI: 78.4%-99.8%), and a NPV of 87.1% (95%CI: 65.2%-95.8%). When combined with the clinical criteria, the FAST exam correlated with the CT scan results (Φ= +0.83; p<0.0001)
Conclusion (implications for practice): A clinical decision rule combining the FAST exam with other clinical findings may be used to guide imaging decisions in select pediatric blunt abdominal trauma.
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