Physical examination as a reliable tool to predict intra-abdominal injuries in brain-injured children

Miller, Douglas; Garza, Jennifer; Tuggle, David; Mantor, Cameron; Puffinbarger, Nikola

doi:10.1016/j.amjsurg.2006.08.036

« Previous Next »The American Journal of Surgery
Volume 192, Issue 6 , Pages 738-742, December 2006

Physical examination as a reliable tool to predict intra-abdominal injuries in brain-injured children

Presented at the 58th Annual Meeting of the Southwestern Surgical Congress, Kauai, Hawaii, April 3–7, 2006

Department of Surgery, Section of Pediatric Surgery, The University of Oklahoma College of Medicine, 940 NE 13th St, Room 2403, Oklahoma City, OK 73104, USA

Received 15 April 2006; received in revised form 10 August 2006

Abstract

Background

Brain-injured children have been thought to have an unreliable abdominal examination. This study evaluates the reliability of physical examination in the prediction of intra-abdominal injury in brain-injured children.

Methods

Pediatric patients with a traumatic brain injury or Glasgow Coma Scale (GCS) <15 and intra-abdominal organ injuries were selected. Admission data were reviewed, and findings were tabulated.

Results

Fifty patients had an abnormal abdominal examination. Nineteen of 71 patients with head injury and intra-abdominal organ injuries required laparotomy. These 19 patients had abdominal tenderness, distention, abrasions, and/or a positive focused abdominal sonography for trauma (FAST) scan. Seven of 19 patients had a GCS of 3. Of the 12 patients requiring surgery with GSC 4 to 14, all patients had abnormal physical examinations.

Conclusions

Patients who required an operation presented with an abnormal examination and/or a positive FAST. These data suggest that examination and/or FAST may reliably identify patients with intra-abdominal organ injuries in need of an operation.

Keywords: Pediatric, Trauma, Abdominal, Brain, FAST, Computed tomography