Hollow Viscus Injuries In Children: Tools For Diagnosis And Timing Of Intervention
Lindsay Dean1, Steven Mehl1, Lucy Hart1, Brittany Johnson2, *Adam Vogel2, *Sara Fallon2, *Bindi Naik-Mathuria2
1Baylor College of Medicine, Houston, TX;2Texas Children's Hospital, Houston, TX
Background (issue): In adults, the Bowel Injury Prediction Score (BIPS), which includes abdominal tenderness, WBC ≥17K, and CT grading, is associated with the need for operative intervention of hollow viscous injuries (HVIs) and delay in diagnosis can lead to mortality. We sought to determine whether BIPS can predict operative HVI in children and whether delayed surgery leads to worse outcomes.
Methods: Single center retrospective review (2014-2019) of children with concern of HVI following blunt abdominal trauma. Sensitivity, specificity, positive and negative predictive value of BIPS and modified BIPS (inclusion of nausea/vomiting) were calculated based on need for operation. Outcomes were compared for HVIs with early (<12 hours) vs delayed (>12 hours) operation.
Findings: Ninety-six patients were identified (58 nonoperative, 13 early operation, 25 delayed operation) with 75 patients having a calculable BIPS. BIPS ≥ 2 had sensitivity 95%, specificity 42%, PPV 37%, NPV 95%, while modified BIPS >3 had a sensitivity 74%, specificity 83%, PPV 79%, NPV 79%. Outcomes were similar for early and delayed operation, except increased LOS for the delayed group (12 vs 6 days; p-value=0.0015).
Conclusions (implications for practice): In children, BIPS may lead to unacceptably high numbers of unnecessary surgery (false positives), although our modified BIPS may be better at predicting need for operation. If the diagnosis of HVI remains unclear, watchful waiting is reasonable as outcomes were similar between early and delayed operative groups.
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