External validation of a pediatric decision rule for blunt abdominal trauma

Area of Science:

• Pediatric Emergency Medicine
• Trauma Surgery
• Radiology

Background:

• Blunt traumatic injuries are a significant cause of pediatric morbidity and mortality.
• Contrast-enhanced multidetector computed tomography (MDCT) is the gold standard for diagnosing blunt abdominal injuries.
• The Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule aids in identifying low-risk pediatric patients who may not require imaging.

Purpose of the Study:

• To validate the PECARN abdominal rule in a non-pediatric specialized hospital setting.
• To assess the rule's performance in identifying pediatric patients with blunt abdominal trauma who require acute intervention.

Main Methods:

• Retrospective review of 794 pediatric patients with blunt trauma from February 2013 to December 2019.
• Exclusion of patients with penetrating trauma or mild isolated head injuries.
• Application of the PECARN decision rule to identify patients needing therapeutic intervention (laparotomy, embolization, transfusion, IV fluids for specific injuries).

Main Results:

• The PECARN clinical decision rule (CDR) demonstrated a sensitivity of 91.3% and a negative predictive value of 99.5%.
• A negative likelihood ratio of 0.16 was observed, indicating strong evidence against significant injury in rule-negative patients.
• Out of 794 patients, 23 required acute intervention.

Conclusions:

• The PECARN blunt abdominal CDR is effective in non-pediatric specialty hospitals.
• Its performance in this setting is comparable to that observed in specialized children's hospitals.
• The rule can reliably identify low-risk pediatric patients, potentially reducing the need for advanced imaging.