MDCalc

Pediatric Surgery Research Collaborative (PedSRC) Rule for Blunt Abdominal Trauma

Identifies patients at very low risk for intra-abdominal injury after trauma.

AST >200 U/L

Abdominal wall trauma, distension, or tenderness on exam

Abnormal chest X-ray

Complaint of abdominal pain

Abnormal amylase or lipase

Result:

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Advice

  • Use results to augment, not replace, clinical judgment; the tool identifies a very low risk cohort rather than dictating imaging.

  • The estimated risk percentage can support shared decision-making with families about imaging that involves ionizing radiation.

  • In children, each abdominal CT scan increases the estimated lifetime risk of radiation-induced fatal cancer by up to ~0.14% (Brenner and Hall, 2007).

Management
  • Patients deemed very low risk for intra-abdominal injury requiring acute intervention may avoid abdominal CT; obtain CT if clinical suspicion persists for significant IAI or if condition evolves.
  • Consider local resources, observation capacity, and the family’s ability to return promptly when planning work-up and disposition.
Critical Actions

Prioritize ABCs and stabilize the child with blunt abdominal trauma before imaging decisions; reassess frequently as new information (exam, labs, imaging) becomes available.

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