Validation of the PECARN Abdominal Rule and FAST-AST/ALT Criteria in Pediatric Blunt Abdominal Trauma: A...

Area of Science:

• Pediatric Emergency Medicine
• Diagnostic Imaging
• Trauma Surgery

Background:

• Accurate diagnosis of intra-abdominal injuries (IAIs) in pediatric blunt abdominal trauma is critical but challenging.
• Clinical decision instruments (CDIs) aid in identifying low-risk children needing acute intervention for IAIs.

Purpose of the Study:

• To compare the diagnostic performance of the Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule versus a focused assessment with sonography in trauma (FAST) with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels rule.
• To evaluate the utility of CDIs in reducing unnecessary computed tomography (CT) scans for pediatric blunt abdominal trauma.

Main Methods:

• Retrospective cohort study of 259 pediatric patients with torso trauma (April 2021-March 2024).
• Comparison of PECARN abdominal rule and FAST with elevated AST/ALT rule using clinical and imaging data.
• Analysis of sensitivity and specificity for identifying intra-abdominal injuries (IAI) and IAI requiring intervention (IAI-I).

Main Results:

• 20 (7.7%) patients developed IAI, with one requiring intervention.
• For IAI-I, PECARN rule: 100% sensitivity, 65.1% specificity; FAST with elevated AST/ALT: 100% sensitivity, 82.2% specificity.
• For IAI, PECARN rule: 90% sensitivity, 69.5% specificity; FAST with elevated AST/ALT: 65.0% sensitivity, 88.7% specificity.

Conclusions:

• The FAST with elevated AST/ALT rule demonstrated higher specificity for identifying IAIs compared to the PECARN rule.
• CDIs, particularly FAST with elevated AST/ALT, show potential in minimizing unnecessary CT scans in pediatric blunt abdominal trauma.
• Further validation in diverse settings and populations is recommended.