External validation of a clinical prediction rule for very low risk pediatric blunt abdominal trauma
| Autor: | Elise Springer, S. Barron Frazier, Donald H. Arnold, Adam A. Vukovic |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Blood transfusion medicine.medical_treatment Abdominal Injuries Clinical prediction rule Wounds Nonpenetrating Revascularization Risk Assessment Fractures Bone Blunt Clinical Decision Rules Laparotomy medicine Humans Blood Transfusion Child Pelvic Bones Retrospective Studies Hematoma business.industry Accidents Traffic General Medicine medicine.disease Intestines Liver Abdominal trauma Child Preschool Emergency medicine Emergency Medicine Fluid Therapy Spinal Fractures Female Tomography X-Ray Computed business Spleen Kappa Pediatric trauma |
| Zdroj: | The American Journal of Emergency Medicine. 37:1643-1648 |
| ISSN: | 0735-6757 |
| DOI: | 10.1016/j.ajem.2018.11.031 |
| Popis: | Background Computed tomography (CT) is frequently used to identify intra-abdominal injuries in children with blunt abdominal trauma (BAT). The Pediatric Emergency Care Applied Research Network (PECARN) proposed a prediction rule to identify children with BAT who are at very low risk for clinically-important intra-abdominal injuries (CIIAI) in whom CT can be avoided. Objective To determine the sensitivity of this prediction rule in identifying patients at very low risk for CIIAI in our pediatric trauma registry. Methods Retrospective review of our institutional trauma registry to identify patients with CIIAI. CIIAI included cases resulting in death, therapeutic intervention at laparotomy, angiographic embolization of intra-abdominal arterial bleeding, blood transfusion for intra-abdominal hemorrhage, and administration of intravenous fluids for two or more nights for pancreatic or gastrointestinal injuries. Patients were identified using ICD diagnosis and procedure codes. Kappa was calculated to evaluate inter-reviewer agreement. Results Of 5743 patients, 133 (2.3%) had CIIAI. 60% were male and the mean age was 8 (SD 4.4) years. One patient with CIIAI met the proposed very low risk criteria, resulting in a prediction rule sensitivity of 99%, 95% CI [96–100%]. This patient also had extra-abdominal arterial bleeding requiring revascularization, offering an alternative reason for transfusion. Kappa was 0.85, 95% CI [0.82, 0.89], indicating strong inter-rater agreement. Conclusions One out of 133 patients with CIIAI met very low risk criteria based on the PECARN prediction rule. This study supports the PECARN clinical prediction rule in decreasing CT use in pediatric patients at very low risk for CIIAI. |
| Databáze: | OpenAIRE |
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