Diagnostic Accuracy of the Blunt Abdominal Trauma Scoring System for Intra-Abdominal Injury in a High-Prevalence Indonesian Trauma Cohort

Abstract

Background: The Blunt Abdominal Trauma Scoring System (BATSS) guides imaging after blunt abdominal trauma, but its accuracy in Indonesian patients already selected for computed tomography (CT) or laparotomy is uncertain.

Objective: To evaluate BATSS diagnostic accuracy for intra-abdominal injury (IAI) in a high-prevalence trauma cohort.

Methods: This retrospective study included patients aged ≥17 years who underwent contrast-enhanced CT or laparotomy in Palembang, Indonesia, from July 2021 to July 2025. Analyses estimated discrimination, threshold accuracy, stratum-specific likelihood ratios (SSLRs), and arithmetic bounds on component frequencies.

Results: Among 37 patients, 34 (91.9%) had IAI. The area under the receiver operating characteristic curve (AUC) was 0.525 (95% CI 0.053–0.996; permutation p = 0.906). At the protocol threshold of ≥12, sensitivity was 64.7% (95% CI 46.5–80.3%) and specificity 66.7% (9.4–99.2%); at ≥10, they were 82.4% and 33.3%. Risk-band SSLRs (0.53, 0.53, 1.94) had confidence intervals spanning 1. Six injured patients scored 2–4. One uninjured patient scored 19, which requires a positive focused assessment with sonography for trauma under BATSS weights; removing that patient raised the AUC to 0.757.

Conclusion: In patients already selected for CT or laparotomy, BATSS did not discriminate IAI, and a low score did not exclude injury. The estimates were fragile. BATSS should not be used to withhold imaging in this setting; prospective multicentre validation including unimaged patients is needed.