Multicenter external validation of the Pediatric Emergency Care Applied Research Network rule to identify children at very low risk for intra-abdominal injury requiring acute intervention

J Trauma Acute Care Surg. 2025 Jun 1;98(6):966-972. doi: 10.1097/TA.0000000000004597. Epub 2025 Apr 2.

Abstract

Background: A clinical prediction rule has been published by the Pediatric Emergency Care Applied Research Network (PECARN) to identify children at very low risk of intra-abdominal injury requiring acute intervention (IAI-intervention) following blunt abdominal trauma in which computed tomography scan of the abdomen could be avoided. This study aims to assess the external validity of the PECARN prediction rule for IAI-intervention and determine its accuracy for identifying all patients with intra-abdominal injuries following blunt abdominal trauma, including those who did not require acute interventions.

Methods: Data were collected prospectively from 14 trauma centers for 2,188 children younger than 16 years who presented following blunt abdominal trauma over a 1-year period. We then retrospectively applied the PECARN prediction rule to this new cohort to risk stratify the patients for intra-abdominal injury (IAI) and IAI-intervention.

Results: A total of 2,188 children with a mean (SD) age of 7.8 (4.6) years were included. The PECARN prediction rule identified 60 of 62 patients with IAI-intervention with a sensitivity of 96.8%, specificity of 46.6%, and a negative predictive value (NPV) of 99.8%. The PECARN prediction rule identified 227 of 261 patients with any IAI with a sensitivity of 86.6%, specificity of 49.7%, and an NPV of 96.5%. The most missed injury by the PECARN rule was liver laceration (n = 22). In addition, 34 of 35 patients with an IAI not predicted by the PECARN rule had an abnormal laboratory value or x-ray finding.

Conclusion: Although the PECARN prediction rule has excellent NPV for identifying patients with intra-abdominal injuries needing an acute intervention, it fails to detect some children with clinically impactful intra-abdominal injuries that required additional management. The addition of trauma bay laboratories and chest x-ray should be used to predict patients at very low risk for all IAI.

Level of evidence: Therapeutic/Care Management; Level III.

Trial registration: ClinicalTrials.gov NCT02206698.

Keywords: Blunt abdominal trauma; acute intervention; prediction rule.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Abdominal Injuries* / diagnosis
  • Abdominal Injuries* / diagnostic imaging
  • Abdominal Injuries* / therapy
  • Adolescent
  • Child
  • Child, Preschool
  • Clinical Decision Rules*
  • Female
  • Humans
  • Infant
  • Male
  • Retrospective Studies
  • Risk Assessment / methods
  • Tomography, X-Ray Computed
  • Trauma Centers
  • Wounds, Nonpenetrating* / diagnosis
  • Wounds, Nonpenetrating* / diagnostic imaging
  • Wounds, Nonpenetrating* / therapy

Associated data

  • ClinicalTrials.gov/NCT02206698