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. 2022 Apr;38(4):589-597.
doi: 10.1007/s00383-022-05067-5. Epub 2022 Feb 6.

Characteristics and predictors of intensive care unit admission in pediatric blunt abdominal trauma

Steven C Mehl  1 , Megan E Cunningham  1 , Christian J Streck  2 , Rowland Pettit  1 , Eunice Y Huang  3 , Matthew T Santore  4 , Kuojen Tsao  5 , Richard A Falcone  6 , Melvin S Dassinger  7 , Jeffrey H Haynes  8 , Robert T Russell  9 , Bindi J Naik-Mathuria  1 , Shawn D St Peter  10 , David Mooney  11 , Jeffrey Upperman  12 , Martin L Blakely  13 , Adam M Vogel  14
Affiliations

Characteristics and predictors of intensive care unit admission in pediatric blunt abdominal trauma

Steven C Mehl et al. Pediatr Surg Int. 2022 Apr.

Abstract

Background: Pediatric trauma patients sustaining blunt abdominal trauma (BAT) with intra-abdominal injury (IAI) are frequently admitted to the intensive care unit (ICU). This study was performed to identify predictors for ICU admission following BAT.

Methods: Prospective study of children (< 16 years) who presented to 14 Level-One Pediatric Trauma Centers following BAT over a 1-year period. Patients were categorized as ICU or non-ICU patients. Data collected included vitals, physical exam findings, laboratory results, imaging, and traumatic injuries. A multivariable hierarchical logistic regression model was used to identify predictors of ICU admission. Predictive ability of the model was assessed via tenfold cross-validated area under the receiver operating characteristic curves (cvAUC).

Results: Included were 2,182 children with 21% (n = 463) admitted to the ICU. On univariate analysis, ICU patients were associated with abnormal age-adjusted shock index, increased injury severity scores (ISS), lower Glasgow coma scores (GCS), traumatic brain injury (TBI), and severe solid organ injury (SOI). With multivariable logistic regression, factors associated with ICU admission were severe trauma (ISS > 15), anemia (hematocrit < 30), severe TBI (GCS < 8), cervical spine injury, skull fracture, and severe solid organ injury. The cvAUC for the multivariable model was 0.91 (95% CI 0.88-0.92).

Conclusion: Severe solid organ injury and traumatic brain injury, in association with multisystem trauma, appear to drive ICU admission in pediatric patients with BAT. These results may inform the design of a trauma bay prediction rule to assist in optimizing ICU resource utilization after BAT.

Study design: Prognosis study.

Keywords: Blunt abdominal trauma; Intensive care; Intra-abdominal injury; Pediatric.

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Conflict of interest statement

Conflict of interest The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Other bodily injuries after blunt abdominal trauma according to ICU admission. Traumatic brain injury only includes moderate and severe classification
Fig. 2
Fig. 2
Tenfold cross-validation ROC curves for ICU admission following pediatric blunt abdominal trauma derived from multivariable hierarchical logistic regression. Mean cvAUC (solid red curve) and k-fold ROC curves (dashed curves --). ROC receiver operating characteristic curve, cvAUC cross-validation area under the curve
See this image and copyright information in PMC

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