R. Lay2, A. Lamoshi6, Z. Chen5, M. Chess3, K. Bass4, D. Wakeman1 2University Of Rochester,School Of Medicine And Dentistry,Rochester, NY, USA 3University Of Rochester,Department Of Imaging Sciences,Rochester, NY, USA 4University at Buffalo,Department Of Pediatric Surgery,Buffalo, NY, USA 1University Of Rochester,Department Of Pediatric Surgery,Rochester, NY, USA 5University at Buffalo,Department Of Biostatistics, School Of Public Health And Health Professions,Buffalo, NY, USA 6Cohen Children’s Medical Center,New York, NY, USA
Introduction: There are no clear indications for abdominal exploration in children who sustain blunt abdominal trauma (BAT) other than the presence of free intraperitoneal air on imaging. We hypothesized that clinical and imaging factors could be used to build a model to predict the need for abdominal surgery in children with BAT. We aimed to validate a predictive model designed for this purpose.
Methods: A retrospective chart review of pediatric patients under 18 years old from our institution’s pediatric trauma database who experienced BAT between 2011 to 2019 was performed. Patients with an abdominal/pelvic computed tomography (CT) scan without free intraperitoneal air were included. Subjects were required to have at least one of the following inclusion criteria: abdominal wall bruising, abdominal pain/tenderness, thoracolumbar fracture, presence of free fluid, and presence of solid organ injury. Pelvic fracture was also included in the current study. Statistical analyses were performed with Fisher’s exact test.
Results: Two hundred nineteen patients met all inclusion criteria; 26 (12%) underwent abdominal exploration. The need for surgical management was significantly associated with the presence of free fluid (p = 0.002) and thoracolumbar fracture (p = 0.001). Abdominal wall bruising, abdominal pain/tenderness, solid organ injury, and pelvic fracture were not significantly associated with the need for surgery. Patients with BAT due to motor vehicle collision were isolated as a subgroup; 12 of 63 (19%) underwent abdominal exploration. Within this group, surgical intervention was significantly associated with free fluid (p = 0.001) and thoracolumbar fracture (p = 0.011). A predictive model incorporating the 6 predictive factors had an area under the receiver operating characteristic curve of 0.75.
Conclusion: The presence of free abdominal fluid on CT and thoracolumbar fracture may be predictive factors in determining the need for abdominal exploration in cases of BAT when there is no clear imaging indication for surgery. Further studies adding patients from other institutions’ databases are needed to determine which variables are important in validating a model to predict the need for abdominal exploration after BAT.
