Performance of individual criteria of the Pediatric Emergency Care Applied Research Network (PECARN) intraabdominal injury prediction rule.

IF 3.4 3区医学 Q1 EMERGENCY MEDICINE

Academic Emergency Medicine Pub Date : 2025-01-13 DOI:10.1111/acem.15084

Cosby G Arnold, Paul Ishimine, Kevan A McCarten-Gibbs, Kenneth Yen, Nisa Atigapramoj, Mohamed Badawy, Irma T Ugalde, Pradip P Chaudhari, Jeffrey S Upperman, Nathan Kuppermann, James F Holmes

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引用次数: 0

Abstract

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^AI). Little is known about the risk for IAI^AI when only one or two prediction rule variables are positive. We sought to determine the risk for IAI^AI 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^AI (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^AI. In the 1347 patients with two rule variables positive, 27 (2.0%, 95% CI 1.3%-2.9%) had IAI^AI. Risk for IAI^AI 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^AI 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^AI. Those with GCS score <14, however, are at highest risk for IAI^AI.

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儿科急诊应用研究网络（PECARN）腹内损伤预测规则的个别标准的表现。

目的：儿科急诊应用研究网络（PECARN）推导并外部验证了一种临床预测规则，用于识别钝性躯干创伤儿童进行急性干预（IAIAI）时低风险的腹内损伤。当只有一两个预测规则变量为正时，对IAIAI的风险知之甚少。当一个或两个PECARN腹内损伤规则变量为阳性时，我们试图确定IAIAI的风险。方法：我们对一项前瞻性多中心研究进行了计划的二次分析，该研究包括7542名儿童（接受治疗性剖腹手术、血管造影栓塞、输血或两晚或两晚以上静脉输液的儿童）。结果：在入组的7542名儿童中，有2986名（39.6%，95%可信区间[CI] 38.5%-40.7%）有1个或2个PECARN变量阳性并被纳入。在这一亚群中，227人（7.6%,95% CI 6.7%-8.6%）有腹内损伤。在仅有一项规则变量阳性的1639例患者中，21例（1.3%,95% CI 0.8%-2.0%）患有IAIAI。在两项规则变量均为阳性的1347例患者中，27例（2.0%,95% CI 1.3%-2.9%）患有IAIAI。当两个变量存在时，格拉斯哥昏迷量表（GCS）评分AI的每个变量发生IAIAI的风险最高，当呼吸音减少时风险最高（44个变量中的3个，6.8%,95% CI 1.4%-18.7%）和GCS结论：很少有钝性躯干创伤和一个或两个PECARN预测变量存在的儿童发生IAIAI。GCS评分为AI。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Emergency Medicine 医学-急救医学

CiteScore

7.60

自引率

6.80%

发文量

207

审稿时长

3-8 weeks

期刊介绍： Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine. The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM''s goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more. Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.