Compliance with evidence-based guidelines for computed tomography of children with head and abdominal trauma

Halaweish, Ihab; Riebe-Rodgers, Jane; Randall, Amy; Ehrlich, Peter F.

doi:10.1016/j.jpedsurg.2017.07.008

Cited by 17 publications

(10 citation statements)

References 6 publications

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“…While traditional predictive models such as logistic and linear regression are feasible, these models can have issues with their implementation and ultimately interpretation by healthcare providers with perceived "black box" results [8,9]. Classification and regression tree analysis (CART) is a technique that is gaining popularity within healthcare due to its ease of interpretation and implementation [8,[10][11][12][13][14][15] Common examples can be noted for guidelines on paediatric head trauma [16][17][18] and paediatric abdominal injuries [19][20][21]. Specifically, CART analysis starts with a large group of individuals, and then makes a series of binary node splits based on some criterion that improves group purity in order to effectively classify individuals.…”

Section: Classification and Regression Tree Analysismentioning

confidence: 99%

Mobility Analysis of AmpuTees (MAAT 4): classification tree analysis for probability of lower limb prosthesis user functional potential

Wurdeman

Stevens

Campbell

2019

Disability and Rehabilitation: Assistive Technology

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Purpose: To develop a predictive model to inform the probability of lower limb prosthesis users' functional potential for ambulation. Materials and Methods: A retrospective analysis of a database of outcomes for 2770 lower limb prosthesis users was used to inform a classification and regression tree analysis. Gender, age, height, weight, body mass index adjusted for amputation, amputation level, cause of amputation, comorbid health status and functional mobility score [Prosthetic Limb Users Survey of Mobility (PLUS-M TM)] were entered as potential predictive variables. Patient K-Level was used to assign dependent variable status as unlimited community ambulator (i.e., K3 or K4) or limited community/household ambulator (i.e., K1 or K2). The classification tree was initially trained from 20% of the sample and subsequently tested with the remaining sample. Results: A classification tree was successfully developed, able to accurately classify 87.4% of individuals within the model's training group (standard error 1.4%), and 81.6% within the model's testing group (standard error 0.82%). Age, PLUS-M TM T-score, cause of amputation and body weight were retained within the tree logic. Conclusions: The resultant classification tree has the ability to provide members of the clinical care team with predictive probabilities of a patient's functional potential to help assist care decisions. ä IMPLICATIONS FOR REHABILITATION Classification and regression tree analysis is a simple analytical tool that can be used to provide simple predictive models for patients with a lower limb prosthesis. The resultant classification tree had an 81.6% (standard error 0.82%) accuracy predicting functional potential as an unlimited community ambulator (i.e., K3 or K4) or limited community/ household ambulator (i.e., K1 or K2) in an unknown group of 2770 lower limb prosthesis users. The resultant classification tree can assist with the rehabilitation team's care planning providing probabilities of functional potential for the lower limb prosthesis user.

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Section: Classification and Regression Tree Analysismentioning

confidence: 99%

Mobility Analysis of AmpuTees (MAAT 4): classification tree analysis for probability of lower limb prosthesis user functional potential

Wurdeman

Stevens

Campbell

2019

Disability and Rehabilitation: Assistive Technology

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“… 23 Both a level 1 trauma center and a pediatric trauma center did not find any improvement in the use of CT imaging after publication of both the PECARN head and abdominal rules. 24 , 25 Further studies are needed on effective strategies to implement the CDR to decrease unnecessary ionizing radiation in children with blunt abdominal trauma.…”

Section: Discussionmentioning

confidence: 99%

External validation of a pediatric decision rule for blunt abdominal trauma

et al. 2022

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Introduction Blunt traumatic injuries are a leading cause of morbidity and mortality in the pediatric population. Contrast‐enhanced multidetector computed tomography is the best imaging tool for screening patients at risk of blunt abdominal injury. The Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule was derived to identify patients at low risk for significant abdominal injury who do not require imaging. Methods We conducted a retrospective review of pediatric patients with blunt trauma to validate the PECARN rule in a non‐pediatric specialized hospital from February 3, 2013, through December 31, 2019. We excluded those with penetrating or mild isolated head injury. The PECARN decision rule was retrospectively applied for the presence of a therapeutic intervention, defined as a laparotomy, angiographic embolization, blood transfusion, or administration of intravenous fluids for pancreatic or gastrointestinal injury. Sensitivity and specificity analysis were conducted along with the negative and positive predictive values. Results A total of 794 patients were included in the final analysis; 23 patients met the primary outcome for an acute intervention. The PECARN clinical decision rule (CDR) had a sensitivity of 91.3%, a negative predictive value of 99.5, and a negative likelihood ration of 0.16. Conclusion In a non‐pediatric specialty hospital, the PECARN blunt abdominal CDR performed with comparable sensitivity and negative predictive value to the derivation and external validation study performed at specialized children's hospitals.

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“…Several authors have tried to limit the indications to certain critical situations [5][6][7][8][9]. Halaweich et al [10] have indeed noticed a decrease in compliance with guidelines for the use of computed tomography in abdominal trauma in children. The reasons are many.…”

Section: Discussionmentioning

confidence: 99%

Management of Pediatric Abdominal Trauma in Countries with Limited Resources: Is Computed Tomography Indispensable for a Good Result?

Assan¹,

Yassegoungbe²,

Seto³

et al. 2021

Preprint

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Background Abdominal trauma are a common cause of infant morbidity and mortality. Aim To assess the relevance of computed tomography scan for the management of abdominal trauma in children in countries with limited resources. Patients and method: It was a retrospective and descriptive study over 5 years in patients aged 0 to 15 years. Results Twenty four cases of abdominal trauma were collected. There were 14 boys and 10 girls with a sex ratio of 1.4. The average age was 8.7 years with extremes of 18 months and 15 years. The causes found were: road accidents (14 cases), home accident (6 cases), gambling accidents (3 cases) and one aggression. Traumas were divided into 83.3% (20 cases) of abdominal blunt and 16.7% (4 cases) of abdominal wound. Polytrauma accounted for 41.7% (10 cases). No computed tomography scan was ordered. The spleen was the most injured organ (11 cases) followed by the intestines (6 cases). The average length of hospital stay was 12.3 days with extremes of 3 and 15 days. The treatment was non-operative in 13 patients (54.2%) and surgical in 11 ones (45.8%). No deaths were noted in our series. Conclusion Abdominal trauma in children are potentially serious injuries. The treatment depends on the damaged organ and the patient's hemodynamic status. Computed tomography scan does not appear to be indispensable in the management of traumatized children in countries with limited resources.

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Compliance with evidence-based guidelines for computed tomography of children with head and abdominal trauma

Cited by 17 publications

References 6 publications

Mobility Analysis of AmpuTees (MAAT 4): classification tree analysis for probability of lower limb prosthesis user functional potential

Mobility Analysis of AmpuTees (MAAT 4): classification tree analysis for probability of lower limb prosthesis user functional potential

External validation of a pediatric decision rule for blunt abdominal trauma

Management of Pediatric Abdominal Trauma in Countries with Limited Resources: Is Computed Tomography Indispensable for a Good Result?

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