A Preliminary Retrospective Analysis of the Blunt Abdominal Trauma Scoring System (BATSS) in a High-Prevalence Cohort: A Single-Center Indonesian Experience

Introduction: The triage of blunt abdominal trauma (BAT) is a critical challenge, and the utility of clinical scoring systems like the blunt abdominal trauma scoring system (BATSS) requires validation in diverse clinical settings. This study aimed to provide a preliminary, critical appraisal of the BATSS's diagnostic performance and the behavior of its individual components in a unique, high-risk cohort at a tertiary Indonesian trauma center. Methods: A retrospective analysis was conducted on 37 BAT patients who underwent definitive diagnostic evaluation (CT scan or laparotomy) between July 2021 and July 2025 in Palembang, Indonesia. The cohort was noted to have a significant selection bias, with an intra-abdominal injury (IAI) prevalence of 91.9% (34 injured, 3 uninjured). A component-level analysis of the seven BATSS variables was performed alongside a standard diagnostic accuracy assessment using an ROC curve to determine the optimal cut-off. Results: The cohort was predominantly young males injured in traffic accidents. The ROC analysis demonstrated poor discriminatory power (AUC = 0.525). At an optimal cut-off of 8.5, BATSS showed a sensitivity of 82.4% and a statistically unstable specificity of 33.3% (95% CI: 0.8% to 90.6%). The PPV was 93.3%, while the NPV was critically low at 14.3%. Component analysis revealed that sensitivity was primarily driven by high-point variables like a positive FAST scan, while low specificity was associated with non-specific signs like abdominal tenderness. Conclusion: In this high-prevalence, pre-selected cohort, BATSS failed to perform as a reliable triage tool. Its poor specificity and dangerously low NPV render it unsuitable and unsafe for ruling out IAI. The score's apparent sensitivity was driven by variables that already indicate a high-risk patient, suggesting the score adds little value to standard clinical assessment. This preliminary study highlights the critical need for robust, large-scale validation before clinical adoption and suggests BATSS may be inappropriate for settings with a high pre-test probability of injury.