Enhancing clinical risk assessment in pediatric blunt abdominal trauma: A novel scoring system using ultrasound and laboratory data.

Abstract

Background: Given the importance of diagnosing intra-abdominal injury (IAI) in children with blunt abdominal trauma (BAT) and preventing radiation exposure to children by avoiding CT scans, this study aimed to evaluate a scoring criterion based on ultrasound (US) findings and laboratory data in assessing the clinical risk of IAI in children with BAT.

Materials and methods: In this retrospective study, baseline and clinical information of 180 children (under 18 years of age) with BAT including physical examination, hemodynamic parameters, and laboratory data, were extracted from medical records. US findings were considered abnormal if any report of mild free fluid or solid organ injury was noted. The presence or absence of IAI was assessed through medical records or telephone interviews to inquire about the patients' outcome within the two-week period post-discharge. The primary outcome was the identification of IAI, assessed through a combination of US findings, physical examination (abdominal tenderness), and laboratory parameters (WBC count and hematuria). The measurement methods included Chi-squared tests, Fisher's exact test, independent samples t-test, logistic regression, and ROC analysis.

Results: The current study showed that 153 (85%) and 27 (15%) patients were without and with IAI, respectively. The positive US finding with sensitivity and specificity of 92.59% and 44.44%, respectively, abdominal tenderness with sensitivity and specificity of 81.48% and 87.58%, respectively, hematuria with sensitivity and specificity of 62.96% and 50.33%, respectively, and high WBC level with sensitivity and specificity of 85.19% and 76.47%, had a significant diagnostic value in detecting the presence of IAI (P value < 0.001). A cutoff point ≥ 2 from the sum of the scores of these four criteria can predict the presence of IAI with a sensitivity of 81.48% and a specificity of 94.12% (AUC = 0.94; P value < 0.001).

Conclusion: This study shows that a scoring system based on positive US findings, abdominal tenderness, hematuria, and high WBC levels effectively diagnoses IAI in BAT children. A score of 2 or more strongly indicates the presence of IAI, improving decision-making for further imaging and treatment. Implementing this system can reduce unnecessary CT scans and radiation exposure, enhancing pediatric trauma care.