儿科急诊护理应用研究网络（PECARN）腹部损伤预测规则各标准的性能。
Performance of individual criteria of the Pediatric Emergency Care Applied Research Network (PECARN) intraabdominal injury prediction rule.
作者信息
Arnold Cosby G, Ishimine Paul, McCarten-Gibbs Kevan A, Yen Kenneth, Atigapramoj Nisa, Badawy Mohamed, Ugalde Irma T, Chaudhari Pradip P, Upperman Jeffrey S, Kuppermann Nathan, Holmes James F
机构信息
Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California, USA.
Department of Emergency Medicine and Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA.
出版信息
Acad Emerg Med. 2025 Jun;32(6):643-649. doi: 10.1111/acem.15084. Epub 2025 Jan 13.
OBJECTIVE
The Pediatric Emergency Care Applied Research Network (PECARN) derived and externally validated a clinical prediction rule to identify children with blunt torso trauma at low risk for intraabdominal injuries undergoing acute intervention (IAI). Little is known about the risk for IAI when only one or two prediction rule variables are positive. We sought to determine the risk for IAI when either one or two PECARN intraabdominal injury rule variables are positive.
METHODS
We performed a planned secondary analysis of a prospective, multicenter study that included 7542 children (<18 years old) with blunt torso trauma evaluated in six emergency departments from December 2016 to August 2021. Patients with only one or two PECARN rule variables positive were included. The outcome was IAI (IAI undergoing therapeutic laparotomy, angiographic embolization, blood transfusion, or two or more nights of intravenous fluids).
RESULTS
Among the 7542 children enrolled, 2986 (39.6%, 95% confidence interval [CI] 38.5%-40.7%) had one or two PECARN variables positive and were included. Of this subpopulation, 227 (7.6%, 95% CI 6.7%-8.6%) had intraabdominal injuries. In the 1639 patients with only one rule variable positive, 21 (1.3%, 95% CI 0.8%-2.0%) had IAI. In the 1347 patients with two rule variables positive, 27 (2.0%, 95% CI 1.3%-2.9%) had IAI. Risk for IAI for each variable was highest for Glasgow Coma Scale (GCS) score <14 (16/291, 5.5%, 95% CI 3.2%-8.8%) and abdominal wall trauma (three of 321, 0.9%, 95% CI 0.2%-2.7%). Risk for IAI when two variables were present was highest when decreased breath sounds (three of 44, 6.8%, 95% CI 1.4%-18.7%) and GCS <14 (10/207, 4.8%, 95% CI 2.3%-8.7%) were present with one other variable.
CONCLUSIONS
Few children with blunt torso trauma and one or two PECARN predictor variables present have IAI. Those with GCS score <14, however, are at highest risk for IAI.
目的
儿科急诊护理应用研究网络（PECARN）制定并外部验证了一项临床预测规则，以识别钝性躯干创伤且有急性干预（IAI）风险的低腹内损伤儿童。对于仅有一两个预测规则变量呈阳性时的IAI风险，人们了解甚少。我们试图确定当PECARN腹内损伤规则变量中有一两个呈阳性时的IAI风险。
方法
我们对一项前瞻性多中心研究进行了计划中的二次分析，该研究纳入了2016年12月至2021年8月在6个急诊科接受评估的7542名（<18岁）钝性躯干创伤儿童。纳入仅有一两个PECARN规则变量呈阳性的患者。结局为IAI（接受治疗性剖腹手术、血管造影栓塞、输血或两晚及以上静脉输液的IAI）。
结果
在纳入的7542名儿童中，2986名（39.6%，95%置信区间[CI]38.5%-40.7%）有一两个PECARN变量呈阳性并被纳入。在该亚组中，227名（7.6%，95%CI 6.7%-8.6%）有腹内损伤。在仅有一个规则变量呈阳性的1639名患者中，21名（1.3%，95%CI 0.8%-2.0%）有IAI。在有两个规则变量呈阳性的1347名患者中，27名（2.0%，95%CI 1.3%-2.9%）有IAI。每个变量的IAI风险在格拉斯哥昏迷量表（GCS）评分<14（16/291，5.5%，95%CI 3.2%-8.8%）和腹壁创伤（321例中有3例，0.9%，95%CI 0.2%-2.7%）时最高。当两个变量同时存在时，IAI风险在呼吸音减弱（44例中有3例，6.8%，95%CI 1.4%-18.7%）和GCS<14（207例中有10例，4.8%，95%CI 2.3%-8.7%）与另一个变量同时存在时最高。
结论
钝性躯干创伤且有一两个PECARN预测变量呈阳性的儿童中，发生IAI的情况很少。然而，GCS评分<14的儿童发生IAI的风险最高。
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