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 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.
Am J Emerg Med. 2019 Sep;37(9):1643-1648. doi: 10.1016/j.ajem.2018.11.031. Epub 2018 Nov 23.
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.
To determine the sensitivity of this prediction rule in identifying patients at very low risk for CIIAI in our pediatric trauma registry.
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.
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.
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.
计算机断层扫描（CT）常用于诊断钝性腹部创伤（BAT）患儿的腹腔内损伤。儿科急诊护理应用研究网络（PECARN）提出了一个预测规则，以识别 BAT 患儿中 CT 可避免的临床重要腹腔内损伤（CIIAI）极低风险的患儿。
在我们的儿科创伤登记处，确定该预测规则在识别 CIIAI 极低风险患者方面的敏感性。
回顾性审查我们机构的创伤登记处，以确定有 CIIAI 的患者。CIIAI 包括导致死亡、剖腹手术治疗、腹腔动脉出血血管造影栓塞、腹腔内出血输血以及胰腺或胃肠道损伤需静脉输注两天以上的病例。使用 ICD 诊断和程序代码识别患者。计算 Kappa 值以评估两位审查者之间的一致性。
在 5743 名患者中，有 133 名（2.3%）患有 CIIAI。60%为男性，平均年龄为 8 岁（标准差 4.4 岁）。1 名患有 CIIAI 的患者符合提出的极低风险标准，预测规则的敏感性为 99%，95%CI[96-100%]。该患者还存在需要血运重建的腹腔外动脉出血，为输血提供了另一种原因。Kappa 值为 0.85，95%CI[0.82,0.89]，表明两位评分者之间具有很强的一致性。
根据 PECARN 预测规则，在 133 名患有 CIIAI 的患者中，有 1 名患者符合极低风险标准。本研究支持 PECARN 临床预测规则在降低 CIIAI 极低风险儿科患者 CT 使用方面的作用。
