Multicenter external validation of the Pediatric Emergency Care Applied Research Network rule to identify children at very low risk for intra-abdominal injury requiring acute intervention.

Document Type

Article

Publication Date

6-2025

Identifier

DOI: 10.1097/TA.0000000000004597

Abstract

BACKGROUND: A clinical prediction rule has been published by the Pediatric Emergency Care Applied Research Network (PECARN) to identify children at very low risk of intra-abdominal injury requiring acute intervention (IAI-intervention) following blunt abdominal trauma in which computed tomography scan of the abdomen could be avoided. This study aims to assess the external validity of the PECARN prediction rule for IAI-intervention and determine its accuracy for identifying all patients with intra-abdominal injuries following blunt abdominal trauma, including those who did not require acute interventions.

METHODS: Data were collected prospectively from 14 trauma centers for 2,188 children younger than 16 years who presented following blunt abdominal trauma over a 1-year period. We then retrospectively applied the PECARN prediction rule to this new cohort to risk stratify the patients for intra-abdominal injury (IAI) and IAI-intervention.

RESULTS: A total of 2,188 children with a mean (SD) age of 7.8 (4.6) years were included. The PECARN prediction rule identified 60 of 62 patients with IAI-intervention with a sensitivity of 96.8%, specificity of 46.6%, and a negative predictive value (NPV) of 99.8%. The PECARN prediction rule identified 227 of 261 patients with any IAI with a sensitivity of 86.6%, specificity of 49.7%, and an NPV of 96.5%. The most missed injury by the PECARN rule was liver laceration (n = 22). In addition, 34 of 35 patients with an IAI not predicted by the PECARN rule had an abnormal laboratory value or x-ray finding.

CONCLUSION: Although the PECARN prediction rule has excellent NPV for identifying patients with intra-abdominal injuries needing an acute intervention, it fails to detect some children with clinically impactful intra-abdominal injuries that required additional management. The addition of trauma bay laboratories and chest x-ray should be used to predict patients at very low risk for all IAI.

LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III.

Journal Title

J Trauma Acute Care Surg

Volume

98

Issue

6

First Page

966

Last Page

972

MeSH Keywords

Humans; Child; Abdominal Injuries; Female; Male; Wounds, Nonpenetrating; Child, Preschool; Tomography, X-Ray Computed; Clinical Decision Rules; Retrospective Studies; Adolescent; Risk Assessment; Trauma Centers; Infant

PubMed ID

40170217

Keywords

Blunt abdominal trauma; acute intervention; prediction rule

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