PECARN abdominal trauma decision rule is designed to reduce use of abdominal CT in pediatric patients.
Inclusion Criteria:
- Age 0 - 18 years old
- Decreased level of consciousness (GCS score < 15 or neurologic/behavioral status not age-appropriate) in association with blunt torso trauma (but not isolated head trauma). Blunt traumatic event with either of the following (regardless of the injury mechanism):
- Paralysis
- Multiple nonadjacent long bone fractures (eg, tibia fracture, ulna fracture)
- Blunt torso trauma due to any of the following mechanisms of injury:
- Motor vehicle crash: high speed (≥ 40mph), rollover, or ejection)
- Falls ≥ 20ft
- Crush injury to the torso
- Physical assault involving the abdomen
- Physician concern for abdominal trauma resulting in any of the following diagnostic or screening tests:
- Abdominal CT or ultrasound (FAST)
- Laboratory testing to screen for intra-abdominal injury
- Chest or pelvic radiography
Study design:
- 12,044 patients enrolled at 20 emergency departments
- Outcomes: emergent laparotomy, angiographic embolization, blood transfusion for intraabdominal bleeding, intravenous fluids for ≥ 2 nights for pancreatic or GI injuries
Study outcomes:
- Sensitivity: 97%
- Specificity: 43%
- NPV: 99.9%
- NLR: 0.07
- Of the 6 patients with important injuries missed by this rule, 5 had distracting injuries or alcohol intoxication
Holmes JA et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013; 62(2):107-16.