View source for EBQ:Validation of a prediction rule for the identification of children with intra-abdominal injuries after blunt torso trauma

{{JC info
| title= Validation of a Prediction Rule for the Identification of Children With Intra-abdominal Injuries After Blunt Torso Trauma
| abbreviation= Validation of a Prediction Rule for the Identification of Children With Intra-abdominal Injuries After Blunt Torso Trauma 
| expansion=Validation of a Prediction Rule for the Identification of Children With Intra-abdominal Injuries After Blunt Torso Trauma
| published= 2009 
| author= Holmes J. et al
| journal= Annals of Emergency Medicine
| year= 2009
| volume= 54
| issue= 4
| pages= 528-33
| pmid= 19250706 
| fulltexturl= http://www.mdconsult.com/das/article/body/432541073-2/jorg=journal&source=&sp=22527614&sid=0/N/713637/1.html?issn=01960644&_returnURL=http%3A//linkinghub.elsevier.com/retrieve/pii/S0196064409000535%3Fshowall%3Dtrue
| pdfurl= http://www.mdconsult.com/das/article/body/432541073-2/jorg=journal&source=&sp=22527614&sid=0/N/713637/s0196064409000535.pdf?issn=0196-0644
}}

==Clinical Question==
What is the accuracy of the prediction rule derived in the publication [http://www.ncbi.nlm.nih.gov.journals.labiomed.org/pubmed/11973557 ''Holmes, JF et al. Identification of children with intra-abdominal injuries after blunt trauma.  Ann Emerg Medicine. 2002;39:500-509.'']  for detecting intra-abdominal injury in children after blunt torso trauma?

==Conclusion==
The clinical decision rule defined by Holmes et al. for ruling out intra-abdominal injury in children with blunt torso trauma would substantially reduce unnecessary abdominal CT in pediatric trauma patients. <br />
Because the rule yielded a false negative in one patient, who underwent diagnostic laparotomy without surgical intervention, it may need further refinement before widespread application.

==Major Points==
6-variable clinical rule test characteristics:<br />
Sensitivity 94.5%<br />
Specificity 37.1%<br />
33% reduction in unnecessary abdominal CT scans

==Inclusion Criteria==
* <18 yr old
* Blunt torso trauma
* Underwent definitive testing for intra-abdominal injury: CT, diagnostic peritoneal lavage, diagnostic laparotomy or laparoscopy.

==Exclusion Criteria==
* Penetrating trauma
* Pregnant patients
* Presentation >24hr after injury
* Patients who did not undergo definitive testing because of low suspicion for intra-abdominal injury

==Interventions== 
 


==Outcome==
 

===Primary Outcomes===
# The presence of intra-abdominal injury<br />
# Intra-abdominal injury requiring acute intervention, defined as: blood transfusion for intra-abdominal hemorrhage, angiographic embolization of vessel or organ, or therapeutic intervention at laparotomy.

===Secondary Outcomes===
Reduction in abdominal CT scans if the rule were to be strictly applied to rule-out intra-abdomninal injury.

===Subgroup analysis===
Children who had intra-abdominal injury missed by the decision rule.

==Criticisms==
The clinical decision rule failed to identify 8 children with an intra-abdominal injury that was ultimately detected on definitive testing.  However, none of these subjects required acute intervention for their injury.

==Funding==
UC Davis Children's Miracle Network Research Grant<br />
SAEM Research Training Grant

==Sources==


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[[Category:EBQ]]