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

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

doi:10.1111/acem.15084

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

Acad Emerg Med. 2025 Jan 13. doi: 10.1111/acem.15084. Online ahead of print.

Authors

Affiliations

¹ Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California, USA.
² Department of Emergency Medicine and Pediatrics, University of California San Diego School of Medicine, La Jolla, California, USA.
³ Department of Emergency Medicine, UCSF Benioff Children's Hospital, Oakland, California, USA.
⁴ Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Health and University of Texas Southwestern, Dallas, Texas, USA.
⁵ Department of Pediatrics, Section of Emergency Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
⁶ Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
⁷ Department of Pediatric Surgery, Vanderbilt University, Nashville, Tennessee, USA.
⁸ Department of Emergency Medicine and Pediatrics, George Washington University School of Medicine, Washington, DC, USA.
⁹ Department of Emergency Medicine and Pediatrics, UC Davis School of Medicine, Sacramento, California, USA.

PMID: 39804061
DOI: 10.1111/acem.15084

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.

Keywords: blunt abdominal trauma; clinical prediction rule; emergency medicine; pediatrics.

Grants and funding

R01HD084674/Eunice Kennedy Shriver National Institute of Child Health and Human Development