儿童钝性腹部创伤（BATiC）评分的外部验证：排除儿童严重腹部损伤。
External validation of the Blunt Abdominal Trauma in Children (BATiC) score: ruling out significant abdominal injury in children.
机构信息
From the Departments of Traumatology (W.-J.J.D.J., D.R.N., M.E.M.), Pediatric Surgery (L.S., J.B.H.), and Epidemiology (H.G.) University Medical Center Groningen (UMCG), Groningen, the Netherlands.
出版信息
J Trauma Acute Care Surg. 2014 May;76(5):1282-7. doi: 10.1097/TA.0000000000000175.
BACKGROUND
The aim of this study was to validate the use of the Blunt Abdominal Trauma in Children (BATiC) score. The BATiC score uses only readily available laboratory parameters, ultrasound results, and results from physical examination and does therefore not carry any risk of additional radiation exposure.
METHODS
Data of pediatric trauma patients admitted to the shock room between 2006 and 2010 were retrospectively analyzed. Blunt abdominal trauma was defined radiologically or surgically. The BATiC score was computed using 10 parameters as follows: abnormal abdominal ultrasound finding, abdominal pain, peritoneal irritation, hemodynamic instability, aspartate aminotransferase greater than 60 U/L, alanine aminotransferase greater than 25 U/L, white blood cell count greater than 10 × 10/L, lactate dehydrogenase greater than 330 U/L, amylase greater than 100 U/L, and creatinine greater than 110 μmol/L. Sensitivity, specificity, negative predictive value, and positive predictive value were computed. Missing values were replaced using multiple imputation, and BATiC scores were calculated based on imputed values.
RESULTS
Included were 216 patients, with 144 males, 72 females, and a median age of 12 years. Eighteen patients (8%) sustained abdominal injury. Median BATiC scores of patients with and without intra-abdominal injury were 9.2 (range, 6.6-15.4) and 2.2 (range, 0.0-10.6) respectively (p < 0.001). When the BATiC score is used with a cutoff point of 6, the test showed a sensitivity of 100% and a specificity of 87%. Negative and positive predictive values were 100% and 41% respectively. The area under the curve was 0.98.
CONCLUSION
The BATiC score can be a useful adjunct in the assessment of the presence of abdominal trauma in children and can help determine which patients might benefit from a computed tomographic scan and/or further treatment and which might not.
LEVEL OF EVIDENCE
Prognostic study, level II.
背景
本研究旨在验证 Blunt Abdominal Trauma in Children（BATiC）评分的使用。BATiC 评分仅使用易于获得的实验室参数、超声结果以及体格检查结果，因此不会带来额外的辐射暴露风险。
方法
回顾性分析了 2006 年至 2010 年间收治于休克病房的儿科创伤患者的数据。采用影像学或手术方法定义钝性腹部创伤。使用以下 10 个参数计算 BATiC 评分：腹部超声异常发现、腹痛、腹膜刺激征、血流动力学不稳定、天门冬氨酸氨基转移酶（AST）>60U/L、丙氨酸氨基转移酶（ALT）>25U/L、白细胞计数（WBC）>10×10/L、乳酸脱氢酶（LDH）>330U/L、淀粉酶（AMY）>100U/L 和肌酐（Cr）>110μmol/L。计算了灵敏度、特异性、阴性预测值和阳性预测值。使用多重插补法替换缺失值，并基于插补值计算 BATiC 评分。
结果
共纳入 216 例患者，其中男 144 例，女 72 例，中位年龄为 12 岁。18 例（8%）患者发生腹部损伤。有和无腹腔内损伤的患者的 BATiC 评分中位数分别为 9.2（范围，6.6-15.4）和 2.2（范围，0.0-10.6）（p<0.001）。当 BATiC 评分的截断值为 6 时，该检测的灵敏度为 100%，特异性为 87%。阴性和阳性预测值分别为 100%和 41%。曲线下面积为 0.98。
结论
BATiC 评分可作为评估儿童腹部创伤的有用辅助手段，有助于确定哪些患者可能受益于计算机断层扫描和/或进一步治疗，哪些患者可能不需要。
证据水平
预后研究，Ⅱ级。
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