الفهرس 
PathophysiologyOnly 14 pages are availabe for public view
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Abstract
observation of a trivial injury is unnecessary. Clinical prediction tools (CPTs) are unlikely to ever achieve 100% sensitivity for the identification of all injuries but the identification of the vast majority of injuries requiring intervention would appear achievable. It should also be noted that CT scanning itself does still miss injuries and that actually the better performing CPTs identified in this study have sensitivities very similar to those described for CT scanning. There are some similar studies done to predict the need of abdominal CT scans in children to avoid the unnecessary exposure to radiation. One of these studies was conducted by, Holmes et al,261 and validated by Springer et al.259 Both of them included pediatric trauma patients aged <16 years. In 2013, Holmes et al. published a prospective study through the Pediatric Emergency Care Applied Research Network (PECARN),which offered a clinical prediction rule to identify a cohort of children with BAT who are at very low-risk of clinically important intra-abdominal injuries. The rule uses seven readily available clinical variables based on history and physical exam: evidence of abdominal wall trauma or seatbelt sign, Glasgow coma score <14, abdominal tenderness, evidence of thoracic wall trauma, abdominal pain, decreased breath sounds, and vomiting.261 Springer et al, validated the PECARN prediction rule and they found only 0.1% of patients who fulfilled the very low-risk criteria were found to have an intra-abdominal injury requiring acute intervention. This resulted in a clinical prediction rule sensitivity of 99%. The abdomen is the third most common injured part and the third most common cause of traumatic death. Blunt abdominal traumas (BAT) are much more frequent than penetrating abdominal traumas and accounts for about 80% of abdominal injuries seen in the emergency department. Computed Tomography is the gold standard for the evaluation of solid organ injures and can detect different grades of injuries and associated complications. CT has some limitations as it is expensive, not easily accessible, exposes the patients to much radiation and also may be inappropriate with haemo- dynamically unstable patients following blunt abdominal trauma Blunt Abdominal Trauma Scoring System (BATSS) was developed in 2014 through a study conducted in two emergency hospitals on adult patients presented with blunt abdominal traumas. It depends on clinical data, FAST and plain x-ray results to predict the presence of intra-abdominal solid organ injuries and the need of abdominal CT scan after blunt abdominal trauma. The aim of this study was to evaluate the reliability of BATSS and find correlations between clinical data and the presence of intraabdominal injuries after blunt abdominal trauma. Our study was conducted as an observational prospective study on 200 patients presented with blunt abdominal trauma. All patients included in the study were subjected to: full history taking, general and abdominal examination, abdominal ultrasound, and CT abdomen or abdominal exploration. Based on the CT findings or operative findings, patients were divided into two groups: group 1 which included 100 patients who had findings of solid organ injury and group 2 that included 100 patients who had no findings of solid organ injury. Motor vehicle collisions (MVC) were the most common mode of trauma (50%) and were more in group 2 than group 1 (69% VS 31%) while falls were more represented in group 1 (34% vs. 8%). Splenic injuries were the most common solid organ injuries representing 72% followed by hepatic injuries and renal injuries (38% and 15% respectively). 24% of patients had combined solid organ injuries (23 had 2 organs and 1 has 3 organs). The BATSS score was calculated for each patient and the results of the two groups were compared. Logistic regression and ROC curve analysis were calculated for the different parameters and BATSS score. Regarding the clinical data “BATSS criteria” there were statistically significant differences between the two groups. In group 2, FAST was negative in all patients. Hypotension (SBP<100 mmhg) found in only one patient and pelvic fracture were in 2 patients. Also there were statistically significant differences between the highest grade organ injury and both the management and BATSS risk groups, p value=0.010. ROC curve analysis between the two groups showed sensitivity for BATSS of 59% for prediction of the presence of intra-abdominal injury after blunt abdominal trauma , with either using the individual patients scores or the risk related to the cutoff point “BATSS < 8” Secondary analysis was done by dividing the patients’ population into group A “injury grade 0-2” and group B “injury grade 3-5”.