Department of Emergency Medicine, Gebze Fatih State Hospital, Kocaeli-Turkey.
Department of Emergency Medicine, Kocaeli University Faculty of Medicine, Kocaeli-Turkey.
Ulus Travma Acil Cerrahi Derg. 2022 Apr;28(4):529-536. doi: 10.14744/tjtes.2020.40156.
The Pediatric Emergency Care Applied Research Network (PECARN) developed a clinical decision rule to identify children at low risk for intra-abdominal injury requiring acute intervention (IAI-I) for reducing unnecessary radiation exposure of ab-dominal computed tomography (CT) after blunt torso trauma. This study aimed to compare the PECARN decision rule with clinician suspicion in identifying children at low risk of intra-abdominal injuries that an abdominal CT scan can be safely avoided.
This study is a retrospective review of children with blunt torso trauma in an academic emergency department (ED) between 2011 and 2019. Patients were considered positive for the PECARN rule if they exhibited any of the variables. Clinician suspi-cion was defined as actual CT ordering of the treating physician. The primary outcome was IAI-I detected by imaging or surgery within 1 month after the trauma, and the secondary outcome was any intra-abdominal injury (IAI) presence.
Among the 768 children included, 48 (6.25%) had intra-abdominal injuries and 21 (2.73%) of whom underwent acute in-tervention. Four hundred and fifty-three (59%) children underwent abdominal CT scanning. If the PECARN rule had been applied, 232 patients would have undergone abdominal CT. The rule revealed 90.48% (95% CI=68.17-98.33%) sensitivity for IAI-I and 81.25% (95% CI=66.9-90.56%) for IAI. Clinician suspicion revealed sensitivities of 100% (95% CI=80.76-00%) and 93.75% (95% CI=81.79-98.37%) for IAI-I and IAI, respectively. Sensitivities of the rule and clinician suspicion were statistically similar for both IAI-I (p=0.5) and IAI (p=0.146).
In this study, the PECARN abdominal rule and clinician suspicion performed similarly in identifying intra-abdominal injuries in children with blunt torso trauma. However, our study supports the use of PECARN abdominal rule in addition to clinical judgment to limit unnecessary abdominal CT use in pediatric patients with blunt torso trauma in the ED.
儿科急诊护理应用研究网络（PECARN）制定了一个临床决策规则，以识别出需要进行急性干预（IAI-I）的低风险腹腔内损伤的儿童，从而减少钝性胸部创伤后腹部 CT 检查的不必要辐射暴露。本研究旨在比较 PECARN 决策规则与临床医生的怀疑，以识别出可以安全避免腹部 CT 扫描的腹腔内损伤风险较低的儿童。
这是一项对 2011 年至 2019 年在学术急诊部门（ED）接受钝性胸部创伤的儿童进行的回顾性研究。如果患儿出现任何变量，则被认为是 PECARN 规则阳性。临床医生的怀疑是指主治医生实际进行 CT 检查。主要结局是创伤后 1 个月内通过影像学或手术发现 IAI-I，次要结局是存在任何腹腔内损伤（IAI）。
在纳入的 768 名儿童中，48 名（6.25%）有腹腔内损伤，其中 21 名（2.73%）接受了急性干预。453 名（59%）儿童接受了腹部 CT 扫描。如果应用 PECARN 规则，232 名患儿将进行腹部 CT 检查。该规则对 IAI-I 的敏感性为 90.48%（95%CI=68.17-98.33%），对 IAI 的敏感性为 81.25%（95%CI=66.9-90.56%）。临床医生的怀疑对 IAI-I 和 IAI 的敏感性分别为 100%（95%CI=80.76-00%）和 93.75%（95%CI=81.79-98.37%）。规则和临床医生怀疑的敏感性在 IAI-I（p=0.5）和 IAI（p=0.146）方面均无统计学差异。
在这项研究中，PECARN 腹部规则和临床医生的怀疑在识别钝性胸部创伤儿童的腹腔内损伤方面表现相似。然而，我们的研究支持在 ED 中对钝性胸部创伤的儿科患者使用 PECARN 腹部规则和临床判断，以限制不必要的腹部 CT 使用。
