Blunt Intra-Abdominal Injury: Likelihood Ratios

Nishijima DK et al. Does this adult patient have a blunt intra-abdominal injury?
JAMA 2012;307(14):1517-27.

Likelihood Ratios [with 95% CI]

Positive LR Negative LR /
History and Physical Exam
Costal margin tenderness 1.4 [1.3-1.7] 0.74 [0.66-0.84]
Abdominal tenderness on exam 1.4 [1.3-1.5] 0.61 [0.46-0.80]
Abdominal pain complaint 1.6 [1.3-2.0] 0.52 [0.34-0.79]
Abdominal guarding 3.7 [2.3-5.9] 0.80 [0.70-0.91]
Abdominal distension 3.8 [1.9-7.6] 0.90 [0.83-0.98]
Abdominal rebound tenderness 6.5 [1.8-24] 0.96 [0.91-1.0]
Abdominal “seat belt sign” in MVC 5.6-9.9 0.53-0.55

Glasgow coma scale < 14 1.8-2.0 0.86-0.87

Presence of femur fracture 2.9 [2.1-4.1] 0.92 [0.88-0.96]
Hypotension on ED arrival (SBP<90) 5.2 [3.5-7.5] 0.90 [0.87-0.94]

Lab Tests
Hematocrit change > 5% 0.91 [0.44-1.9] 1.0 [0.79-1.4]
Serum lactate > 2.2 mmol/L 1.3 [1.1-1.5] 0.61 [0.41-0.90]
Serum WBC > 10K 1.7 [1.5-2.0] 0.35 [0.23-0.55]
Hematocrit < 36% 2.2 [1.6-3.1] 0.76 [0.64-0.90]
Hematocrit < 30% 3.3 [2.4-4.5] 0.79 [0.71-0.88]
AST > 50 U/L 2.5 [2.0-3.0] 0.38 [0.26-0.56]
AST or ALT > 130 U/L 5.2 [3.5-7.9] 0.46 [0.33-0.65]
Hematuria > 50 RBC/hpf 3.7 [2.4-5.8] 0.44 [0.25-0.77]
Hematuria > 25 RBC/hpf 4.1 [3.4-4.9] 0.66 [0.60-0.72]
Base deficit < -6 mEq/L 18 [11-30] 0.12 [0.06-0.24]

Imaging
Abnormal pelvic xray 1.6 [0.78-3.4] 0.96 [0.90-1.0]
Abnormal chest xray 2.5-3.8 0.70-0.96
FAST ultrasound 30 [20-46] 0.26 [0.19-0.34]
(adjusted for publication bias)