Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision
Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting. The purpose of this study was to explore objective findings that may aid in det...
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| Veröffentlicht in: | The Journal of emergency medicine 2018-01, Vol.54 (1), p.1-7 |
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| creator | Drucker, Natalie A. McDuffie, Lucas Groh, Eric Hackworth, Jodi Bell, Teresa M. Markel, Troy A. |
| description | Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting.
The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC.
Data from 2010–2014 at an American College of Surgeons–certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p |
| doi_str_mv | 10.1016/j.jemermed.2017.08.008 |
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The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC.
Data from 2010–2014 at an American College of Surgeons–certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p < 0.05 was considered statistically significant.
Eight hundred sixty-two patients 0–18 years of age presented to the hospital after an MVC during the study period. Seventeen patients (2.0%) required abdominal exploration and all were found to have intraabdominal injuries. Respiratory rate was the only vital sign that was significantly altered (p = 0.04) in those who required abdominal surgery compared with those who did not. Physical examination findings, such as the seat belt sign, abdominal bruising, abdominal wound, and abdominal tenderness, were present significantly more frequently in those requiring abdominal surgery (p < 0.0001). Each finding had a negative predictive value for the need for operative exploration of at least 0.98. There were no significant differences in trauma laboratory values or radiographic findings between the 2 groups.
Data from this study solidify the relationship between specific physical examination findings and the need for abdominal exploration after MVC in children. In addition, these data suggest that a lack of the seat belt sign, abdominal bruising, abdominal wounds, or abdominal tenderness are individually predictive of patients who will not require surgical intervention.</description><identifier>ISSN: 0736-4679</identifier><identifier>EISSN: 2352-5029</identifier><identifier>DOI: 10.1016/j.jemermed.2017.08.008</identifier><identifier>PMID: 29107481</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abdominal Injuries - diagnosis ; Abdominal Pain - etiology ; Accidents, Traffic - statistics & numerical data ; Adolescent ; Chi-Square Distribution ; Child ; Child, Preschool ; children ; Female ; General Surgery - methods ; General Surgery - statistics & numerical data ; Humans ; Infant ; injury ; Male ; motor vehicle crash ; Pediatric Emergency Medicine - methods ; Pediatric Emergency Medicine - standards ; Physical Examination - methods ; Physical Examination - standards ; Retrospective Studies ; seat belt sign ; Trauma Centers - organization & administration ; Trauma Centers - statistics & numerical data</subject><ispartof>The Journal of emergency medicine, 2018-01, Vol.54 (1), p.1-7</ispartof><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c471t-4c53eb9c294914b75ad7f679012231d1685830e8fed87f2e065c6c2892ef5afe3</citedby><cites>FETCH-LOGICAL-c471t-4c53eb9c294914b75ad7f679012231d1685830e8fed87f2e065c6c2892ef5afe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0736467917307138$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29107481$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Drucker, Natalie A.</creatorcontrib><creatorcontrib>McDuffie, Lucas</creatorcontrib><creatorcontrib>Groh, Eric</creatorcontrib><creatorcontrib>Hackworth, Jodi</creatorcontrib><creatorcontrib>Bell, Teresa M.</creatorcontrib><creatorcontrib>Markel, Troy A.</creatorcontrib><title>Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision</title><title>The Journal of emergency medicine</title><addtitle>J Emerg Med</addtitle><description>Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting.
The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC.
Data from 2010–2014 at an American College of Surgeons–certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p < 0.05 was considered statistically significant.
Eight hundred sixty-two patients 0–18 years of age presented to the hospital after an MVC during the study period. Seventeen patients (2.0%) required abdominal exploration and all were found to have intraabdominal injuries. Respiratory rate was the only vital sign that was significantly altered (p = 0.04) in those who required abdominal surgery compared with those who did not. Physical examination findings, such as the seat belt sign, abdominal bruising, abdominal wound, and abdominal tenderness, were present significantly more frequently in those requiring abdominal surgery (p < 0.0001). Each finding had a negative predictive value for the need for operative exploration of at least 0.98. There were no significant differences in trauma laboratory values or radiographic findings between the 2 groups.
Data from this study solidify the relationship between specific physical examination findings and the need for abdominal exploration after MVC in children. In addition, these data suggest that a lack of the seat belt sign, abdominal bruising, abdominal wounds, or abdominal tenderness are individually predictive of patients who will not require surgical intervention.</description><subject>Abdominal Injuries - diagnosis</subject><subject>Abdominal Pain - etiology</subject><subject>Accidents, Traffic - statistics & numerical data</subject><subject>Adolescent</subject><subject>Chi-Square Distribution</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>children</subject><subject>Female</subject><subject>General Surgery - methods</subject><subject>General Surgery - statistics & numerical data</subject><subject>Humans</subject><subject>Infant</subject><subject>injury</subject><subject>Male</subject><subject>motor vehicle crash</subject><subject>Pediatric Emergency Medicine - methods</subject><subject>Pediatric Emergency Medicine - standards</subject><subject>Physical Examination - methods</subject><subject>Physical Examination - standards</subject><subject>Retrospective Studies</subject><subject>seat belt sign</subject><subject>Trauma Centers - organization & administration</subject><subject>Trauma Centers - statistics & numerical data</subject><issn>0736-4679</issn><issn>2352-5029</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUV1vFCEUJUZjt9W_0PDoy0yBYRjmxVg3rZpUbeLHK2GZyw4bBirMtq6_XtZtG33yiXA5H5dzEDqlpKaEirNNvYEJ0gRDzQjtaiJrQuQTtGBNy6qWsP4pWpCuERUXXX-EjnPekAIkkj5HR6ynpOOSLtCv63GXndEeX_zUkwt6djFgl_E8An4LecbXCQZn5phwtH-mnwAGbMv9fDXEPcXjL9u0hrTDLuDl6PyQIODL6H28c2GNP8Y9-zuMznjAyzJ3ubi8QM-s9hle3p8n6Nvlxdfl--rq87sPy_OryvCOzhU3bQOr3rCe95SvulYPnS1_IpSxhg5UyFY2BKSFQXaWARGtEYbJnoFttYXmBL0-6N5sVyUvA2FO2qub5Caddipqp_59CW5U63irWilawUkReHUvkOKPbclETS4b8F4HiNusaC-o4JR3rEDFAWpSzDmBfbShRO2LUxv1UJzaF6eIVKW4Qjz9e8lH2kNTBfDmAIAS1a2DpLJxEEwpJ4GZ1RDd_zx-A8Bwr5k</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Drucker, Natalie A.</creator><creator>McDuffie, Lucas</creator><creator>Groh, Eric</creator><creator>Hackworth, Jodi</creator><creator>Bell, Teresa M.</creator><creator>Markel, Troy A.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20180101</creationdate><title>Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision</title><author>Drucker, Natalie A. ; McDuffie, Lucas ; Groh, Eric ; Hackworth, Jodi ; Bell, Teresa M. ; Markel, Troy A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c471t-4c53eb9c294914b75ad7f679012231d1685830e8fed87f2e065c6c2892ef5afe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Abdominal Injuries - diagnosis</topic><topic>Abdominal Pain - etiology</topic><topic>Accidents, Traffic - statistics & numerical data</topic><topic>Adolescent</topic><topic>Chi-Square Distribution</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>children</topic><topic>Female</topic><topic>General Surgery - methods</topic><topic>General Surgery - statistics & numerical data</topic><topic>Humans</topic><topic>Infant</topic><topic>injury</topic><topic>Male</topic><topic>motor vehicle crash</topic><topic>Pediatric Emergency Medicine - methods</topic><topic>Pediatric Emergency Medicine - standards</topic><topic>Physical Examination - methods</topic><topic>Physical Examination - standards</topic><topic>Retrospective Studies</topic><topic>seat belt sign</topic><topic>Trauma Centers - organization & administration</topic><topic>Trauma Centers - statistics & numerical data</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Drucker, Natalie A.</creatorcontrib><creatorcontrib>McDuffie, Lucas</creatorcontrib><creatorcontrib>Groh, Eric</creatorcontrib><creatorcontrib>Hackworth, Jodi</creatorcontrib><creatorcontrib>Bell, Teresa M.</creatorcontrib><creatorcontrib>Markel, Troy A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Drucker, Natalie A.</au><au>McDuffie, Lucas</au><au>Groh, Eric</au><au>Hackworth, Jodi</au><au>Bell, Teresa M.</au><au>Markel, Troy A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision</atitle><jtitle>The Journal of emergency medicine</jtitle><addtitle>J Emerg Med</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>54</volume><issue>1</issue><spage>1</spage><epage>7</epage><pages>1-7</pages><issn>0736-4679</issn><eissn>2352-5029</eissn><abstract>Exploratory laparotomy in children after motor vehicle collision (MVC) is rare. In the absence of definitive hemorrhage or free abdominal air on radiographic imaging, predictors for operative exploration are conflicting.
The purpose of this study was to explore objective findings that may aid in determining which children require operative abdominal exploration after MVC.
Data from 2010–2014 at an American College of Surgeons–certified level 1 pediatric trauma center were retrospectively reviewed. Demographics, vital signs, laboratory data, radiologic studies, operative records, associated injuries, and outcomes were analyzed and p < 0.05 was considered statistically significant.
Eight hundred sixty-two patients 0–18 years of age presented to the hospital after an MVC during the study period. Seventeen patients (2.0%) required abdominal exploration and all were found to have intraabdominal injuries. Respiratory rate was the only vital sign that was significantly altered (p = 0.04) in those who required abdominal surgery compared with those who did not. Physical examination findings, such as the seat belt sign, abdominal bruising, abdominal wound, and abdominal tenderness, were present significantly more frequently in those requiring abdominal surgery (p < 0.0001). Each finding had a negative predictive value for the need for operative exploration of at least 0.98. There were no significant differences in trauma laboratory values or radiographic findings between the 2 groups.
Data from this study solidify the relationship between specific physical examination findings and the need for abdominal exploration after MVC in children. In addition, these data suggest that a lack of the seat belt sign, abdominal bruising, abdominal wounds, or abdominal tenderness are individually predictive of patients who will not require surgical intervention.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>29107481</pmid><doi>10.1016/j.jemermed.2017.08.008</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Abdominal Injuries - diagnosis Abdominal Pain - etiology Accidents, Traffic - statistics & numerical data Adolescent Chi-Square Distribution Child Child, Preschool children Female General Surgery - methods General Surgery - statistics & numerical data Humans Infant injury Male motor vehicle crash Pediatric Emergency Medicine - methods Pediatric Emergency Medicine - standards Physical Examination - methods Physical Examination - standards Retrospective Studies seat belt sign Trauma Centers - organization & administration Trauma Centers - statistics & numerical data |
| title | Physical Examination is the Best Predictor of the Need for Abdominal Surgery in Children Following Motor Vehicle Collision |
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