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Predicting Pancreatitis in Children With Blunt Abdominal Trauma
Matthew S Marks1, Anna Liveris2, Stephen M Blumberg1
1Departments of Pediatrics (Emergency Medicine).
Objectives:
To describe the characteristics of children presenting with blunt abdominal trauma who have pancreatitis, and to describe the performance of the Pediatric Emergency Care Applied Research Network (PECARN) prediction rule in identifying pancreatitis.
Methods:
This was a secondary analysis of data collected by the PECARN Intra-abdominal Injury Study Group. The data set included 12,044 patients <18 years who presented to the Emergency Department with blunt abdominal trauma. Risk factors were evaluated for association with pancreatic injury using bivariate analysis.
Results:
Of the children with blunt abdominal trauma, 7384 (61%) were males, and the median age was 11 years (interquartile range, 5 to 15 years); 761 (6%) had an intra-abdominal injury and 105 (1%) had pancreatitis. Children with pancreatitis were more likely to be hospitalized [85 (81%) vs. 5906 (49%), P <0.001], require surgery [21 (20%) vs. 111 (1%), P <0.001], or die within 30 days [4 (4%) vs. 96 (1%), P =0.01], than those without. Pancreatic enzyme testing was ordered inconsistently in the Emergency Department [5889 (49%)]. Computed tomography was performed in 37 (35%) patients with pancreatitis, but was positive in only 29 (78%). The PECARN prediction rule, when applied to pancreatitis, demonstrated a sensitivity of 99% (95% CI, 95%-100%) and a specificity of 42% (95% CI, 41%-43%).
Conclusions:
Traumatic pancreatitis is uncommon but associated with significant morbidity and mortality. Pancreatic enzyme testing is not ordered consistently. Computed tomography misses about a quarter of cases of pancreatitis. Utilizing the PECARN prediction rule can help identify children at risk for pancreatic injuries, potentially leading to improved management and outcomes.
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