Development and Validation of a Novel Hollow Viscus Injury Prediction Score for Abdominal Seatbelt Sign: A Pacific Coast Surgical Association Multicenter Study

Jeffrey Santos, Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
Patrick T. Delaplain, Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
Erika Tay-Lasso, Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
Walter L. Biffl, Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA.
Kathryn B. Schaffer, Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA.
Margaret Sundel, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Mira Ghneim, Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.
Todd W. Costantini, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA.
Jarrett E. Santorelli, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA.
Emily Switzer, Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA.
Morgan Schellenberg, Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA.
Jessica A. Keeley, Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
Dennis Y. Kim, Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA.
Andrew Wang, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Navpreet K. Dhillon, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Deven Patel, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Eric M. Campion, Department of Surgery, Denver Health Medical Center, Denver, CO.
Caitlin K. Robinson, Department of Surgery, Denver Health Medical Center, Denver, CO.
Susan Kartiko, Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC.
Megan T. Quintana, Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
Jordan M. Estroff, Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC.
Katharine A. Kirby, Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, California, USA.
Areg Grigorian, Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA.
Jeffry Nahmias, Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA.

Document Type

Journal Article

Publication Date

9-13-2023

Journal

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000000863

Abstract

BACKGROUND: High-quality computed tomography (CT) can exclude HVI in patients with an A-SBS but performs poorly at identifying HVI. Delay in diagnosis of HVI has significant consequences necessitating timely identification. STUDY DESIGN: This multicenter, prospective observational study conducted at nine trauma centers between August 2020-October 2021 included adult trauma patients with A-SBS who underwent abdominal CT prior to surgery. HVI was determined intra-operatively and physiologic, examination, laboratory, and imaging findings were collected. Lasso and probit regression selected predictor variables and coefficients were used to assign integer points for the HVI Score. Validation was performed by comparing area under receiver operating curves (AUROC). RESULTS: Analysis included 473 in the development set and 203 in the validation set. The HVI Score includes initial systolic blood pressure < 110mmHg, abdominal tenderness, guarding, and select abdominal CT findings. The derivation set has an AUROC of 0.96 and the validation set has an AUROC of 0.91. The HVI Score ranges from 0-17 with score 0-5 having a HVI risk of 0.03-5.36%, 6-9 having a risk of 10.65-44.1%, and 10-17 having a risk of 58.59-99.72%. CONCLUSIONS: This multicenter study developed and validated a novel HVI Score incorporating readily available physiologic, examination, and CT findings to risk stratify patients with an abdominal SBS. The HVI Score can be used to guide decisions regarding management of a patient with an abdominal SBS and suspected HVI.

Department

Surgery

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