Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department
Yıl: 2022 Cilt: 28 Sayı: 4 Sayfa Aralığı: 529 - 536 Metin Dili: İngilizce DOI: 10.14744/tjtes.2022.40156 İndeks Tarihi: 10-05-2023
Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department
Öz: BACKGROUND: The Pediatric Emergency Care Applied Research Network (PECARN) developed a clinical decision rule to identify children at low risk for intra-abdominal injury requiring acute intervention (IAI-I) for reducing unnecessary radiation exposure of abdominal computed tomography (CT) after blunt torso trauma. This study aimed to compare the PECARN decision rule with clinician suspicion in identifying children at low risk of intra-abdominal injuries that an abdominal CT scan can be safely avoided. METHODS: This study is a retrospective review of children with blunt torso trauma in an academic emergency department (ED) between 2011 and 2019. Patients were considered positive for the PECARN rule if they exhibited any of the variables. Clinician suspicion was defined as actual CT ordering of the treating physician. The primary outcome was IAI-I detected by imaging or surgery within 1 month after the trauma, and the secondary outcome was any intra-abdominal injury (IAI) presence. RESULTS: Among the 768 children included, 48 (6.25%) had intra-abdominal injuries and 21 (2.73%) of whom underwent acute intervention. Four hundred and fifty-three (59%) children underwent abdominal CT scanning. If the PECARN rule had been applied, 232 patients would have undergone abdominal CT. The rule revealed 90.48% (95% CI=68.17–98.33%) sensitivity for IAI-I and 81.25% (95% CI=66.9–90.56%) for IAI. Clinician suspicion revealed sensitivities of 100% (95% CI=80.76–00%) and 93.75% (95% CI=81.79–98.37%) for IAI-I and IAI, respectively. Sensitivities of the rule and clinician suspicion were statistically similar for both IAI-I (p=0.5) and IAI (p=0.146). CONCLUSION: In this study, the PECARN abdominal rule and clinician suspicion performed similarly in identifying intra-abdominal injuries in children with blunt torso trauma. However, our study supports the use of PECARN abdominal rule in addition to clinical judgment to limit unnecessary abdominal CT use in pediatric patients with blunt torso trauma in the ED.
Anahtar Kelime: Acil serviste künt gövde travmalı çocuklardaki intraabdominal yaralanmayı öngörmede PECARN klinik karar kuralı ile klinisyen şüphesinin karşılaştırılması
Öz: AMAÇ: Çocuklarda künt travma sonrası yaralanmaları tanımada kullanılan abdominal bilgisayarlı tomografiye (BT) bağlı gereksiz radyasyon maruziyetini azaltmak için The Pediatric Emergency Care Applied Research Network (PECARN) grubu karıniçi yaralanma için düşük riskli çocukları tanımlamak amacıyla bir klinik karar kuralı tanımladı. Bu çalışmanın amacı; künt gövde travması sonrası karıniçi yaralanma riski düşük olan, bilgisayarlı tomografiden güvenle kaçınılabilecek çocukları tanımlamada PECARN klinik karar kuralı ile klinisyen şüphesinin performanslarını karşılaştırmaktır. GEREÇ VE YÖNTEM: Bu çalışmada akademik bir acil servise 2011–2019 yılları arasında künt gövde travması ile başvuran çocuklar geriye dönük olarak gözden geçirildi. PECARN değişkenlerinden herhangi birinin varlığı pozitif olarak kabul edildi. Klinisyen şüphesi de doktorun abdominal BT istemesi olarak tanımlandı. Çalışmanın birincil sonlanım ölçütü girişim gerektiren intraabdominal yaralanma, sekonder sonlanım ölçütü de herhangi bir karıniçi yaralanma varlığı idi. BULGULAR: Analiz edilen 768 çocuğun 21’inin (%2.73) akut girişim gerektirdiği 48’inde (%6.25) karıniçi yaralanma mevcuttu. Çocukların 453’üne (%59) abdominal BT çekildi. PECARN klinik karar kuralı uygulansaydı 232 çocuğa BT çekilecekti. PECARN kuralı girişim gerektiren karıniçi yaralanma için %90.48 (%95 GA = %68.17–%98.33) ve herhangi bir yaralanma varlığı için %81.25 (%95 GA = %66.9–%90.56) duyarlılık gösterdi. Klinisyen şüphesi ise sırasıyla girişim gerektiren yaralanmayı ve herhangi bir yaralanma varlığını öngörme için %100 (%95 GA = %80.76–%100) ve %93.75 (%95 GA = %81.79–%98.37) duyarlılıkta idi. Karar kuralı ve klinisyen şüphesinin karıniçi yaralanma için düşük riskli çocukları öngörme performansları girişim gerektiren yaralanmalarda (p=0.5) ve yaralanma varlığında (p=0.146) istatistiksel olarak benzerdi. TARTIŞMA: Bu çalışmada PECARN karın kuralı ve klinisyen şüphesi, acil servisteki künt gövde travmalı çocuklardaki karıniçi yaralanmaları öngörmede benzer performans gösterdiler. Bununla birlikte, çalışmamız bu çocuklarda gereksiz abdominal BT çekilmesini sınırlandırmak için klinik yargıya ek olarak PECARN klinik karar kuralının kullanımını desteklemektedir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | TAŞ S, Yaka E, Yilmaz S, DOĞAN N, Ozturan I, Pekdemir M (2022). Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. , 529 - 536. 10.14744/tjtes.2022.40156 |
| Chicago | TAŞ SEVİNÇ,Yaka Elif,Yilmaz Serkan,DOĞAN NURETTİN ÖZGÜR,Ozturan Ibrahim Ulas,Pekdemir Murat Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. (2022): 529 - 536. 10.14744/tjtes.2022.40156 |
| MLA | TAŞ SEVİNÇ,Yaka Elif,Yilmaz Serkan,DOĞAN NURETTİN ÖZGÜR,Ozturan Ibrahim Ulas,Pekdemir Murat Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. , 2022, ss.529 - 536. 10.14744/tjtes.2022.40156 |
| AMA | TAŞ S,Yaka E,Yilmaz S,DOĞAN N,Ozturan I,Pekdemir M Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. . 2022; 529 - 536. 10.14744/tjtes.2022.40156 |
| Vancouver | TAŞ S,Yaka E,Yilmaz S,DOĞAN N,Ozturan I,Pekdemir M Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. . 2022; 529 - 536. 10.14744/tjtes.2022.40156 |
| IEEE | TAŞ S,Yaka E,Yilmaz S,DOĞAN N,Ozturan I,Pekdemir M "Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department." , ss.529 - 536, 2022. 10.14744/tjtes.2022.40156 |
| ISNAD | TAŞ, SEVİNÇ vd. "Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department". (2022), 529-536. https://doi.org/10.14744/tjtes.2022.40156 |
| APA | TAŞ S, Yaka E, Yilmaz S, DOĞAN N, Ozturan I, Pekdemir M (2022). Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. Ulusal Travma ve Acil Cerrahi Dergisi, 28(4), 529 - 536. 10.14744/tjtes.2022.40156 |
| Chicago | TAŞ SEVİNÇ,Yaka Elif,Yilmaz Serkan,DOĞAN NURETTİN ÖZGÜR,Ozturan Ibrahim Ulas,Pekdemir Murat Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. Ulusal Travma ve Acil Cerrahi Dergisi 28, no.4 (2022): 529 - 536. 10.14744/tjtes.2022.40156 |
| MLA | TAŞ SEVİNÇ,Yaka Elif,Yilmaz Serkan,DOĞAN NURETTİN ÖZGÜR,Ozturan Ibrahim Ulas,Pekdemir Murat Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. Ulusal Travma ve Acil Cerrahi Dergisi, vol.28, no.4, 2022, ss.529 - 536. 10.14744/tjtes.2022.40156 |
| AMA | TAŞ S,Yaka E,Yilmaz S,DOĞAN N,Ozturan I,Pekdemir M Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 529 - 536. 10.14744/tjtes.2022.40156 |
| Vancouver | TAŞ S,Yaka E,Yilmaz S,DOĞAN N,Ozturan I,Pekdemir M Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department. Ulusal Travma ve Acil Cerrahi Dergisi. 2022; 28(4): 529 - 536. 10.14744/tjtes.2022.40156 |
| IEEE | TAŞ S,Yaka E,Yilmaz S,DOĞAN N,Ozturan I,Pekdemir M "Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department." Ulusal Travma ve Acil Cerrahi Dergisi, 28, ss.529 - 536, 2022. 10.14744/tjtes.2022.40156 |
| ISNAD | TAŞ, SEVİNÇ vd. "Comparison of PECARN clinical decision rule and clinician suspicion in predicting intra-abdominal injury in children with blunt torso trauma in the emergency department". Ulusal Travma ve Acil Cerrahi Dergisi 28/4 (2022), 529-536. https://doi.org/10.14744/tjtes.2022.40156 |
