Majid Shojaee,Gholamreza Faridaalaee,Mahmoud Yousefifard,Mehdi Yaseri,Ali Arhami Dolatabadi,Anita Sabzghabaei,Ali Malekirastekenari.[J].Chin J Traumatol,2014,17(1):19-24. [doi]
New scoring system for intra-abdominal injury diagnosis after blunt trauma
  
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KeyWord: Abdominal injuries  Tomography, X-ray computed  Diagnosis
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Author NameAffiliation
Majid Shojaee Emergency Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran 
Gholamreza Faridaalaee Emergency Medicine Department, Urmia University of Medical Sciences, Urmia, Iran 
Mahmoud Yousefifard Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 
Mehdi Yaseri Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran 
Ali Arhami Dolatabadi Emergency Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran 
Anita Sabzghabaei Emergency Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran 
Ali Malekirastekenari Emergency Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran 
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Abstract:
      Objective: An accurate scoring system for intra-abdominal injury(IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. Methods: This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. Results: Altogether 261 patients (80.1% male) were enrolled (48 cases of IAI).A24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score<8), moderate (8≤score<12) and high risk (score≥12). In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%). Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%). The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%). Conclusion: The present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.
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