A Single-Center Evaluation of a Novel Hollow Viscus Injury Prediction Score for Abdominal Seatbelt Sign.

Abstract

Background: The diagnosis of hollow viscus injury (HVI) following blunt trauma presents a challenge in the acute clinical setting. The recently derived HVI score uses clinical and imaging findings to predict HVI with scores ranging from 0-17 (low risk: 0-5, moderate risk: 6-9, and high risk: 10-17). This study aimed to determine how frequently the use of the HVI score would change management in a cohort of patients with an abdominal seat belt sign (SBS). Methods: This was a retrospective, single-center study including all adult (18 years and older) patients with abdominal SBS. Patients were assigned risk categories based on HVI score. We compared the patients' actual management with management recommended by the HVI score (low risk: observation; moderate risk: CT or diagnostic laparoscopy/laparotomy; high risk: diagnostic laparoscopy/laparotomy). Results: In total, 239 patients were included. The HVI score had a 98.3% NPV and 12.4% PPV for the low-risk cutoff score (HVI ≤5), while the NPV and PPV for the high-risk cutoff (HVI score ≥10) were 97.7% and 50%, respectively. Within the moderate-risk category, 97.9% did not originally follow HVI score recommendations, and among these patients, 2.1% were later found to have an HVI. Out of all patients, 2.1% had delayed diagnoses of HVI and may have benefitted from earlier identification with the HVI score. Discussion: Thus, the HVI score appears capable of detecting HVI in patients with abdominal SBS. An HVI score ≤5 nearly excludes HVI, while an HVI score ≥10 helps predict need for intervention in a timelier manner.