Validation of Blunt Abdominal Trauma Severity Scoring System for Predicting Surgical Intervention: A Prospective Study

Abstract

Blunt abdominal trauma accounts for 7–10% of all trauma fatalities, and deciding which patients require surgery versus observation remains clinically challenging. The Blunt Abdominal Trauma Severity Scoring System (BATSS) combines seven bedside parameters into a 24-point score, but prospective validation in an Indian tertiary care setting had not been undertaken. This prospective observational study enrolled 67 patients aged 18–50 years presenting with blunt abdominal trauma at a tertiary care teaching hospital in Bengaluru between November 2020 and June 2022. Each patient was scored at admission before imaging and stratified as low risk (score <8), moderate risk (8–11), or high risk (≥12). Sensitivity, specificity, positive and negative predictive values, likelihood ratios and area under the receiver-operating-characteristic curve (AUC) were calculated at the pre-specified cut-off of ≥12. Forty-five patients (67.2%) were high risk, seven (10.4%) moderate risk and 15 (22.4%) low risk. Of 21 patients requiring surgical intervention, 20 (95.2%) were in the high-risk group. FAST was positive in all 45 high-risk patients (100%) and negative in all 15 low-risk patients. At the cut-off of ≥12, sensitivity was 95.2% (95% CI 77.3–99.2%), specificity 45.7% (32.2–59.8%), positive predictive value 44.4% (30.9–58.8%), negative predictive value 95.5% (78.2–99.2%), negative likelihood ratio 0.10 and AUC 0.71 (0.58–0.84). The association between high-risk BATSS category and surgical intervention was significant (p = 0.003). In-hospital mortality was 4.5%. BATSS demonstrated high sensitivity and negative predictive value for identifying blunt abdominal trauma patients requiring surgery, supporting its role as a bedside rule-out triage tool. Multicentre validation is recommended.