Pediatric blunt trauma: a small study validates PECARN decision rule

  • Springer E & al.
  • Am J Emerg Med
  • 23 Nov 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • This validation study found that the Pediatric Emergency Care Applied Research Network (PECARN) rule accurately rules out clinically important intra-abdominal injuries (CIIAI) in children who have sustained blunt abdominal trauma (BAT). 
  • Prospective multicenter study needed.

Why this matters

  • This study seeks to validate PECARN’s rule to predict which children do not require CT after BAT.
  • Rule weighs 7 factors: evidence of abdominal wall trauma or seatbelt sign, Glasgow coma score, abdominal tenderness, thoracic wall trauma, abdominal pain, breath sounds, and vomiting.

Key results

  • 1 patient with CIIAI would have been deemed very low risk by the PECARN rule; this patient had extra-abdominal arterial bleeding.
  • Sensitivity: 99% (95% CI, 95.9-100).

Study design

  • Single-center retrospective registry study of 5743 pediatric trauma patients at a level 1 trauma center, 133 with CIIAI.
  • Outcome: sensitivity of PECARN prediction rule.
  • Funding: None.

Limitations

  • Small study.
  • Criteria not designed to rule out pelvic and/or spinal injuries.