259 Imaging for Pediatric Blunt Abdominal Trauma: Different Prediction Rules, Is the Outcome the Same?

Abstract

Computerized tomography (CT) of abdominal/pelvis is the standard modality to diagnose intra-abdominal injury (IAI). Clinicians must weigh the risk-benefit of CT compared to degree of clinical suspicion of an IAI. PECARN (Pediatric Emergency Care Applied Research Network), BATIC (Blunt abdominal trauma in children) and Streck prediction rules have been published to help guide evaluation of these patients. PECARN uses history and physical examination findings, while BATIC and Streck use exam plus laboratory and imaging findings. Currently, there is not one gold standard protocol used in literature. Our goal is to compare these different prediction rules. This was a retrospective electronic chart review of all children age <18 years presenting for either Level 1 or 2 trauma activations at our pediatric emergency department between June 1st 2015 through June 30th 2017. Charts were manually reviewed for a mechanism concerning for abdominal trauma and demographic data, history and physical examination findings, laboratory and imaging results per prediction rules, revisits in 7 days were collected. The prediction rules were applied to all charts that had all data necessary. A score of zero for PECARN and Streck and score <5 for BATIC were defined as “low risk.” Patients with no CT, negative CT, and no new injury found on revisit were classified as “no IAI identified” and patients with positive CT or revisit with injury found as “IAI identified.” The results were compared via Fisher’s exact test. 249 patients met inclusion criteria with median age of 12 years. Overall 27 patients had positive CT results. Out of the low-risk patients, 119/121 (98.7%) in PECARN group, 48/56 (85.7%) in BATIC group and 21/21 (100%) in Streck group had no IAI identified. (Table 1) None of the low risk patients required any intra-abdominal intervention. No missed IAI was identified during revisits. Negative predictive values for the rules were significant for PECARN, BATIC and Streck (98.35%, 85.71% and 100%, respectively) (Table 2). PECARN and Streck have high NPV to predict low-risk patients who do not require CT. When laboratory studies are not done, PECARN is an effective means of excluding IAI for low-risk patients. Batic and Streck cohorts were smaller due to a large number of cases with missing data which could be due to clinician discretion of not obtaining labs due to well appearance of child. Overall, the results are similar to the past individual studies done on each rule. History and physical examination findings are of high importance and if there are no abnormal findings, patients with blunt torso trauma may not need further evaluation. This is the only study found in literature that has compared 3 different prediction rules.View Large Image Figure ViewerDownload Hi-res image Download (PPT)