Holmes J F, Sokolove P E, Land C, Kuppermann N
Department of Internal Medicine, University of California, Davis, School of Medicine, USA.
Acad Emerg Med. 1999 Aug;6(8):799-806. doi: 10.1111/j.1553-2712.1999.tb01210.x.
To determine the utility of the ED physical examination and laboratory analysis in screening hospitalized pediatric blunt trauma patients for intra-abdominal injuries (IAIs).
The authors reviewed the records of all patients aged <15 years who sustained blunt traumatic injury and were admitted to a Level 1 trauma center over a four-year period. Patients were considered high-risk for IAI if they had any of the following at ED presentation: decreased level of consciousness (GCS < 15), abdominal pain, tenderness on abdominal examination, or gross hematuria. Patients without any of these findings were considered moderate risk for LAI. The authors compared moderate-risk patients with and without IAIs with regard to physical examination and laboratory findings obtained in the ED.
Of 1,040 children with blunt trauma, 559 (54%) were high-risk and 481 (46%) were moderate-risk for IAI. 126 (23%) of the high-risk and 22 (4.6%) of the moderate-risk patients had IAIs. Among moderate-risk patients with and without IAIs, those with IAIs were more likely to have abdominal abrasions (5/22 vs 34/459, p = 0.008), an abnormal chest examination (11/22 vs 86/457, p = 0.01), higher mean serum concentrations of aspartate aminotransferase (AST) (604 U/L vs 77 U/L, p < 0.001) and alanine aminotransferase (ALT) (276 U/L vs 39 U/L, p = 0.002), higher mean white blood cell (WBC) counts (16.3 K/mm3 vs 12.8 K/mm3, p < 0.001), and a higher prevalence of >5 RBCs/hpf on urinalysis (7/22 vs 54/427, p = 0.02). There was no significant difference (p > 0.05) between moderate-risk patients with and without IAIs in initial serum concentrations of amylase, initial hematocrit, drop in hematocrit >5 percentage points in the ED, or initial serum bicarbonate concentrations.
In children hospitalized for blunt torso trauma who are at moderate risk for IAI, ED findings of abdominal abrasions, an abnormal chest examination, and microscopic hematuria as well as elevated levels of AST and ALT, and elevated WBC count are associated with IAI.
确定急诊科体格检查和实验室分析在筛查住院的小儿钝性创伤患者腹内损伤（IAIs）中的效用。
作者回顾了所有年龄小于15岁、遭受钝性创伤并在四年期间入住一级创伤中心的患者的记录。如果患者在急诊科就诊时有以下任何一种情况，则被认为IAI风险高：意识水平下降（格拉斯哥昏迷量表＜15）、腹痛、腹部检查有压痛或肉眼血尿。没有这些发现的患者被认为LAI风险中等。作者比较了有和没有IAIs的中度风险患者在急诊科获得的体格检查和实验室检查结果。
在1040名钝性创伤儿童中，559名（54%）IAI风险高，481名（46%）风险中等。高风险患者中有126名（23%）、中度风险患者中有22名（4.6%）有IAIs。在有和没有IAIs的中度风险患者中，有IAIs的患者更有可能有腹部擦伤（5/22对34/459，p = 0.008）、胸部检查异常（11/22对86/457，p = 0.01）、平均血清天冬氨酸转氨酶（AST）浓度更高（604 U/L对77 U/L，p＜0.001）和丙氨酸转氨酶（ALT）浓度更高（276 U/L对39 U/L，p = 0.002）、平均白细胞（WBC）计数更高（16.3 K/mm3对12.8 K/mm3，p＜0.001）以及尿分析中每高倍视野红细胞＞5个的患病率更高（7/22对54/427，p = 0.02）。有和没有IAIs的中度风险患者在淀粉酶初始血清浓度、初始血细胞比容、急诊科血细胞比容下降＞5个百分点或初始血清碳酸氢盐浓度方面没有显著差异（p＞0.05）。
在因钝性躯干创伤住院且IAI风险中等的儿童中，急诊科发现腹部擦伤、胸部检查异常、镜下血尿以及AST和ALT水平升高、WBC计数升高与IAI相关。
