الفهرس 
Blunt Abdominal Trauma(BAT)Only 14 pages are availabe for public view
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Abstract
Trauma is still the leading cause of death for children even in well-developed and wealthy countries. Abdominal trauma accounts for about 10% of trauma in children and is considered the leading cause of morbidity and mortality in children. The ”Advanced Trauma Life Support” (ATLS) protocol of the American College of Surgeons’ Committee on Trauma has been established as a standard procedure algorithm for the initial assessment and management of poly-traumatized patients. In blunt polytrauma patients, the early phase of the “golden hour” is not restricted to management within just the first 60 min after injury only and should be extended to the first few hours after trauma. The established time-dependent management phases for trauma patients include: primary survey, damage control surgery, secondary survey and delayed primary surgery. Several studies have tried to define an accurate scoring system that can predict the severity of pediatric trauma and possible outcomes, and hence many scoring systems have been developed for stratifying trauma in pediatric patients. Yet, all these scoring systems have some limitations in predicting the prognosis of an injured child. The most common pediatric trauma scores are the Pediatric Trauma Score (PTS) and the Blunt Abdominal Trauma in Children (BATiC) score. In our study, we chose the BATiC because of their easy applicability and because the BATiC is the only specific score to predict absence of BAT in traumatized children. The aim of the study was to evaluate the efficacy of the Blunt Abdominal Trauma in Children (BATiC) score and modify its use in infants and young children presenting with blunt abdominal trauma as an early predictor for intra-abdominal injuries in Emergency Department, Tanta University Hospital. ➢ Patients and method: Our study was carried out on (119) patients who were admitted to Tanta University Emergency Hospital from October 2017 till October 2018. We included patients younger than 18 years old, patients with isolated blunt abdominal trauma, and patients with acute trauma. Patients ˃ 18 years old, patients with major head injury, major chest injury, penetrating injuries, major burns, patients with trauma > 24 hours, patients with insufficient history about the trauma, and patients with associated chronic disabling diseases were excluded from our study. According to ATLS, our management included the following: a rapid primary survey, resuscitation of vital functions, a more detailed secondary survey and finally initiation of definitive care. BATiC score was calculated based on its parameters including FAST, hemodynamic instability, abdominal pain, peritoneal irritation, AST, ALT, WBCs, LDH, lipase and creatinine. According to BATiC score patients were categorized into; group I: 14 cases this group includes patients with a BATiC score of 14-18. group II: 18 cases this group includes patients with a BATiC score of 10-13 and group III: 87 cases this group include patients with a BATiC score <10. Another classification based on Karam O, et al (2009); [120] was made into those with BATiC score ˃ 7 and those with BATiC score ≤ 7 Before discharge, patients were classified into group A: with proven intraabdominal organ injury by CT or laparotomy, and group B: with non-proven intraabdominal organ injury by CT or laparotomy. Demographic data, mode of trauma, mode of transfer, time from the accident to arrival, vital data, hemodynamic instability on arrival and after 24hrs, admission, outcome and management all were recorded. ➢ Results: Our study included 119 patients with BAT over a period of one year. The age of our patients ranged from 4 to 18 years old with a mean of age 9.29 years old. Sixtyeight (68) cases were males and 51 cases were females. RTAs were the most common mode of trauma (68 cases); followed by falling from height; (46 cases) and direct abdominal trauma was in (5 cases). Seventy-two (72 cases) were presented by ambulance referred from other hospitals, 44 cases presented to us by private cars by relatives or witnesses and 3 cases presented by the ambulance directly from the accident site. The time from the accident to arrival in group I and group II ranged between 1-4 hours and in group III it ranged between 1-5 hours. On arrival, 94 cases were hemodynamically stable and 25cases were hemodynamically unstable. Fifty-four (54 cases) showed abdominal pain. Peritoneal irritation was present in 52 cases. FAST findings: 47 cases (39.49%) showed IPFF only with no organ injury, splenic injury; 46 cases (38.65%), hepatic injury; 22 (18.48%), renal injury; 2 cases (1.68%) and renal and splenic injury; 1 case (0.84%). Only 70 cases were subjected to CT abdomen and pelvis with IV contrast. Cases were admitted either to surgery ward 71 cases, ICU 43 cases while 5 cases were transferred from resuscitation room immediately to the OR. One hundred and thirteen cases (94.95%) responded to conservative treatment and only 6 cases (5.04%) required surgical exploration and organ resection. By using the 3 group’s classification BATiC score was valid in 83 cases (69.7%) and not valid in 36 cases (30.2%). The score was more accurate in patients with high score in groups (I & II). By using a cutoff value of ≤ 7 introduced by Karam O, et al (2009); [120] we found that: ➢ In the group with BATiC score ≤ 7; (53 cases) 44.5% cases; BATiC score was valid in 29 cases (54.7%) and not valid in 24 cases (45.3%) so, specificity of 54.7%. ➢ In the group with BATiC score ˃ 7; (66 cases) 55.5% cases; BATiC score was valid in 47 cases (71.2) and not valid in 19 cases (28.8%) so, the score has sensitivity of 71.2%