Predictors of Solid Organ Injury Following Blunt Abdominal Trauma: A Single Institution Process Improvement Initiative

Background: Computed tomography (CT) scan remains the gold standard for identifying solid organ injuries (SOI) following blunt abdominal trauma but subjects the child to ionizing radiation, requires transportation out of the emergency department, may require sedation, and has a significant cost. Methods: We performed a 5-year retrospective review of a prospectively collected trauma database at a Level One Pediatric Trauma Center to determine the best screening tools for identifying SOI prior to obtaining a CT scan. Results: Forty-three patients with SOI (paired with 47 agematched controls) were included. Univariate logistic regression analysis demonstrated the following factors to be predictive of SOI: complaint of abdominal pain (p=0.021); tenderness on abdominal exam (p=0.001); and abnormal lipase (p=0.013), AST (p=0.037), or ALT (p=0.001). Vital signs, hemoglobin, amylase, and alkaline phosphatase did not predict SOI. On multivariate analysis abdominal tenderness, abnormal lipase, and abnormal ALT remained significant (p-values 0.006, 0.049, and 0.002, respectively). Conclusions: In this single institution process improvement initiative, not all laboratory studies routinely obtained in injured patients predicted SOI. Physical exam remains an important part of the trauma evaluation. Utilizing this data, we can devise a more cost effective method to screen for SOI and limit CT scan use in injured children.