Validation of PECARN as a clinical decision rule for CT imaging of children with blunt abdominal trauma: a single centre retrospective cohort study.

Abstract

Background: Blunt traumatic injuries are the leading cause of morbidity and mortality in children. Contrast enhanced computed tomography (CT) is the best imaging tool for screening patients at risk of blunt abdominal injury. Concerns existed on potential overuse and the radiation risks. We aim at evaluating paediatric use of trauma CT scan.

Methods: Children with traumatic injuries who attended a tertiary trauma centre from January 2000 to December 2024 were included to evaluate the use of trauma CT scan and patterns of paediatric abdominal trauma. We excluded those with penetrating or isolated head injury. The Pediatric Emergency Care Applied Research Network (PECARN) algorithm was applied retrospectively with the aim of validating the use of PECARN.

Results: Total of 1138 paediatic trauma admissions were identified during the study period and 70% (n 802) had blunt trauma. 483 patients were included after excluding patients with isolated head injury and missing data. 90 days trauma related mortality was 0.7% with one patient died within 24 hours of admission. Overall Injury Severity Score (ISS) was 3.52±5.95 which appeared to increase with age (rho 0.289, p <0.01).111 patients received CT scan, among which 35 are whole body CT. Significant findings were detected in 30% of these scans, 25 required intervention. Patients with higher trauma index and lower GCS, trauma call activation, older aged at presentation were more likely to receive a scan (p<0.001). No pathology was missed in the no CT group. PECARN validation was performed on 200 patients, There were no missed scans and pathologies in PECARN negative patients. Sensitivity was 100%, specificity was 96.5%, negative predictive value was 100%.

Conclusion: A significant portion of children had negative trauma CT scan and did not need intervention. Use of clinical decision rule is warranted in identifying children at lower risk to minimize unnecessary imaging.