Abstract
Background
Computed tomography (CT) is frequently used to identify intra-abdominal injuries in
children with blunt abdominal trauma (BAT). The Pediatric Emergency Care Applied Research
Network (PECARN) proposed a prediction rule to identify children with BAT who are
at very low risk for clinically-important intra-abdominal injuries (CIIAI) in whom
CT can be avoided.
Objective
To determine the sensitivity of this prediction rule in identifying patients at very
low risk for CIIAI in our pediatric trauma registry.
Methods
Retrospective review of our institutional trauma registry to identify patients with
CIIAI. CIIAI included cases resulting in death, therapeutic intervention at laparotomy,
angiographic embolization of intra-abdominal arterial bleeding, blood transfusion
for intra-abdominal hemorrhage, and administration of intravenous fluids for two or
more nights for pancreatic or gastrointestinal injuries. Patients were identified
using ICD diagnosis and procedure codes. Kappa was calculated to evaluate inter-reviewer
agreement.
Results
Of 5743 patients, 133 (2.3%) had CIIAI. 60% were male and the mean age was 8 (SD 4.4)
years. One patient with CIIAI met the proposed very low risk criteria, resulting in
a prediction rule sensitivity of 99%, 95% CI [96–100%]. This patient also had extra-abdominal
arterial bleeding requiring revascularization, offering an alternative reason for
transfusion. Kappa was 0.85, 95% CI [0.82, 0.89], indicating strong inter-rater agreement.
Conclusions
One out of 133 patients with CIIAI met very low risk criteria based on the PECARN
prediction rule. This study supports the PECARN clinical prediction rule in decreasing
CT use in pediatric patients at very low risk for CIIAI.
Keywords
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Article Info
Publication History
Published online: November 22, 2018
Accepted:
November 21,
2018
Received in revised form:
November 17,
2018
Received:
September 21,
2018
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
