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External validation of a clinical prediction rule for very low risk pediatric blunt abdominal trauma

  • Author Footnotes
    1 Pediatric Emergency Medicine Associates, Children's Hospital at Erlanger, 910 Blackford Street, Chattanooga, TN, 37403 (present address).
    Elise Springer
    Footnotes
    1 Pediatric Emergency Medicine Associates, Children's Hospital at Erlanger, 910 Blackford Street, Chattanooga, TN, 37403 (present address).
    Affiliations
    Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA
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  • S. Barron Frazier
    Affiliations
    Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA
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  • Donald H. Arnold
    Affiliations
    Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA

    Department of Pediatrics, Division of Pulmonary Medicine and the Center for Asthma Research, Vanderbilt University School of Medicine, 2200 Children's Way, Nashville, TN 37232, USA
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  • Adam A. Vukovic
    Correspondence
    Corresponding author at: Division of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 1025, Nashville, TN 37232, USA.
    Affiliations
    Department of Pediatrics, Division of Pediatric Emergency Medicine, Vanderbilt University Medical Center, 2200 Children's Way Suite 1025, Nashville, TN 37232, USA
    Search for articles by this author
  • Author Footnotes
    1 Pediatric Emergency Medicine Associates, Children's Hospital at Erlanger, 910 Blackford Street, Chattanooga, TN, 37403 (present address).
Published:November 22, 2018DOI:https://doi.org/10.1016/j.ajem.2018.11.031

      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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