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

incomplete Journal Club Article
Holmes J. et al. "Validation of a Prediction Rule for the Identification of Children With Intra-abdominal Injuries After Blunt Torso Trauma". Annals of Emergency Medicine. 2009. 54(4):528-33.
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Clinical Question

What is the accuracy of the prediction rule derived in the publication 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?


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.
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:
Sensitivity 94.5%
Specificity 37.1%
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



Primary Outcomes

  1. The presence of intra-abdominal injury
  2. 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.


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.


UC Davis Children's Miracle Network Research Grant
SAEM Research Training Grant