Cousin Ianis, Hardouin Lucile, Linard Caroline, Cousin Elie, Germouty Isabelle, Abalea Lydie, Couturaud Francis, de Vries Philine
Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire de Brest, Hôpital Augustin Morvan, 4 Avenue Foche, 29200, Brest, France.
Laboratoire Intéraction Epithélium Neurones, Université de Bretagne Occidentale, 6 rue Colbert, 29200, Brest, France.
Eur J Trauma Emerg Surg. 2021 Feb;47(1):105-112. doi: 10.1007/s00068-019-01214-1. Epub 2019 Aug 27.
The clinical process for the diagnosis of intra-abdominal lesion due to blunt abdominal trauma in children is not consistent. The goal of the present study was to assess the efficiency of our institutional procedure to manage hemodynamically stable pediatric patients with benign abdominal trauma and to select patients who need a radiological examination in an emergency pediatric department.
This was a prospective cohort study from June 2008 to June 2010 in a pediatric emergency department. Pediatric patients with benign abdominal trauma and with stable hemodynamic parameters were included in the study. We conducted first clinical examination and clinical laboratory assessment for blood count, platelet count, hematocrit, serum glutamo-oxalacétique transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), lipase and urine. A second clinical examination was performed 2 h later. Patients with biological abnormalities and/or with persistent pain underwent a computerized tomography (CT) of the abdomen. Our main criterion for judging was the presence of intra-abdominal lesion as revealed by the scan, which was considered as the gold standard. At the second clinical examination, patients without pain and with normal results for clinical laboratory assessment were sent home. A telephone call was made to the children 48 h after the visit to the hospital emergency department. The secondary criterion for judging was the absence of complication in children who did not undergo the scan.
A total of 111 children were included. Seventy-five children underwent the complete procedure. Thirty-four scans were performed. The scan revealed that 22 patients had an intra-abdominal lesion. Multivariate analysis indicated that SGOT higher than 34 IU/L and the persistence of pain for more than 2 h from the initial evaluation of trauma favored the development of intra-abdominal lesion. On the basis of these two criteria, we developed a predictive diagnostic score for post-traumatic intra-abdominal injuries with a high negative predictive value. For children who were sent home without a radiological examination, no complications were observed at 48 h after the visit to the emergency department.
The present protocol is a good approach to identify children at risk for intra-abdominal lesion who need a radiological examination and those who do not require any complementary examinations. The predictive diagnostic score could help young hospital doctors to assess blunt abdominal trauma.
儿童钝性腹部创伤所致腹腔内病变的临床诊断过程并不一致。本研究的目的是评估我院处理血流动力学稳定的良性腹部创伤儿科患者的程序的有效性，并在儿科急诊科筛选出需要进行放射学检查的患者。
这是一项于2008年6月至2010年6月在一家儿科急诊科进行的前瞻性队列研究。纳入研究的是患有良性腹部创伤且血流动力学参数稳定的儿科患者。我们首先进行了临床检查以及血常规、血小板计数、血细胞比容、血清谷草转氨酶（SGOT）、血清谷丙转氨酶（SGPT）、脂肪酶和尿液的临床实验室评估。2小时后进行了第二次临床检查。有生物学异常和/或持续疼痛的患者接受了腹部计算机断层扫描（CT）。我们的主要判断标准是扫描显示的腹腔内病变的存在，这被视为金标准。在第二次临床检查时，无疼痛且临床实验室评估结果正常的患者被送回家。在患儿到医院急诊科就诊48小时后进行了电话随访。次要判断标准是未接受扫描的儿童无并发症。
共纳入111名儿童。75名儿童完成了整个流程。进行了34次扫描。扫描显示22例患者存在腹腔内病变。多变量分析表明，SGOT高于34 IU/L以及自创伤初始评估起疼痛持续超过2小时有利于腹腔内病变的发生。基于这两个标准，我们制定了一个具有高阴性预测价值的创伤后腹腔内损伤预测诊断评分。对于未进行放射学检查就被送回家的儿童，在急诊科就诊48小时后未观察到并发症。
本方案是识别有腹腔内病变风险、需要进行放射学检查的儿童以及那些不需要任何补充检查的儿童的良好方法。该预测诊断评分有助于年轻的医院医生评估钝性腹部创伤。
