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In a large cohort of children, the risk of intraabdominal injury (IAI) with one or two PECARN variables is low, with GCS <14 at highest risk.
Refining CT use in pediatric blunt torso trauma
A 2013 PECARN study derived a clinical prediction rule to identify children with blunt torso trauma who are at very low risk for intraabdominal injuries needing acute intervention (IAIAI). This rule has been validated to identify children who do not need a CT, but the risk for intraabdominal injuries in children with one or two positive rule variables remained unclear. In this secondary analysis of a prospective, multicenter study (n=7,542), IAIAI was identified in 1.3% (95%CI 0.8–2.0%) of children with one positive PECARN rule variable and 2.0% (95%CI 1.3–2.9%) of those with two positive rule variables. Among the PECARN prediction rule variables, Glasgow Coma Scale <14 was the strongest predictor, with an IAIAI occurrence of 5.5% (95%CI 3.2–8.8%). This study clarifies the risk associated with one or two positive PECARN rule variables, which was previously unclear and reinforces the predictive value of the PECARN clinical prediction rule for intraabdominal injuries in children with blunt torso trauma. This study is limited by its focus on large pediatric trauma centers, potential variability in clinician assessment of PECARN variables, and the small sample size for certain predictor combinations, which may limit the generalizability and precision of risk estimates.
How will this change my practice?
While the PECARN IAI prediction rule was validated with high sensitivity, this study clarifies the risk associated with one or two positive PECARN rule variables. Similar to the PECARN Head Trauma rule, it is helpful to understand the risk of serious injury that comes along with specific risk factors. Results from this study can help reduce CT imaging and the associated radiation in those children with isolated abdominal pain, vomiting, or abdominal tenderness.
Source
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. Epub ahead of print. PMID: 39804061
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Dr. Joshua Belfer, MD, is a Pediatric Emergency Medicine physician at the Children’s Hospital of Philadelphia, and is the Founder and Editor-in-Chief of HipPEMcrates. He can be reached at HipPEMcrates@gmail.com.
