PECARN is a wonderful thing. Any individual pediatric facility sees a handful of children. A handful, however, multiplied by 20, becomes potentially practice-changing.
And, this is an article further exploring the PECARN pediatric abdominal trauma prediction instrument, comparing its utility to typical clinician judgment. As part of the initial derivation study, the surveyors asked each clinician to rate the likelihood of intra-abdominal injury, stratified <1%, 1-5%, 6-10%, 11-50%, or >50%. Turns out, clinician judgement wasn’t too bad.
- Of 9,252 children with <1% chance of injury requiring intervention, 35 (0.4%) had injuries identified.
- Of 1,793 between 1-5% chance, 40 (2.2%).
- Of 506 between 6-10% chance, 33 (6.5%).
- Of 281 between 11-50% chance, 59 (21.0%).
- Of 81 greater 50% chance, 36 (41.4%).
The problem with these data? 5,318 CTs were performed to identify 203 significant injuries, including 3,016 in those with <1% chance.
The prediction rule was both better and worse. It was more sensitive than clinician judgment, but also less specific. For an endeavor attempting to decrease CT utilization in children, it’s still not quite clear where this fits in – and whether using it in a fashion similar to PERC or D-dimer wouldn’t necessarily increase imaging. It may, as these authors discuss, have more value in Emergency Departments without the same level of comfort managing traumatically injured children, as it may yet in face reduce imaging in that context.
“Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra-abdominal Injuries After Blunt Torso Trauma”