External validation of a pediatric decision rule for blunt abdominal trauma

Sigal, Adam; Deaner, Traci; Woods, Sam; Mannarelli, Elizabeth; Müller, Alison; Martin, Anthony; Schoener, Alexis; Brower, McKenna; Ong, Adrian W.; Geng, Thomas; Guillen, Felipe; Lahmann, Brian; Wasser, Tom; Valente, Cristina

doi:10.1002/emp2.12623

Cited by 4 publications

(1 citation statement)

References 23 publications

(34 reference statements)

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“…A negative FAST alone does not rule-out IAI, the presence of trace FF does not necessarily equate to presence of IAI, and the operator-dependent nature can also affect its accuracy. To mitigate these limitations, it is recommended to combine FAST findings with clinical findings, or to integrate it with other clinical decision rules such as the PECARN IAI rule [56]. Successful clinical integration of FAST requires an appreciation of its nuances and limitations, and a familiarity of performing a FAST with accuracy as well as technical fluency to minimize nonvalue-added time.…”

Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

Lee,

Sweetnam-Holmes,

Soffer

et al. 2024

Current Opinion in Pediatrics

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Purpose of review There is expanding evidence for point-of-care ultrasound (POCUS) use in pediatric emergency medicine – this review highlights the benefits and challenges in the clinical integration of high-yield POCUS applications. Specifically, it will delve into POCUS applications during resuscitations, controversies of Focused Assessment with Sonography for Trauma (FAST) in pediatric trauma, POCUS-guided procedures, and examples of clinical pathways where POCUS can expedite definitive care. Recent findings POCUS can enhance diagnostic accuracy and aid in management of pediatric patients in shock and help identify reversible causes during cardiac arrest. The use of the FAST in pediatric blunt abdominal trauma remains nuanced – its proper use requires an integration with clinical findings and an appreciation of its limitations. POCUS has been shown to enhance safety and efficacy of procedures such as nerve blocks, incision & drainage, and intravenous access. Integrating POCUS into pathways for conditions such as intussusception and testicular torsion expedites downstream care. Summary POCUS enhances diagnostic efficiency and management in pediatric patients arriving at the ED with undifferentiated shock, cardiac arrest, or trauma. Additionally, POCUS improves procedural success and safety, and is integral to clinical pathways for expediting definitive care for various pediatric emergencies. Future research should continue to focus on the impact of POCUS on patient outcomes, ensuring user competency, and the expansion of POCUS into diverse settings.

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Section: Contrast-enhanced Ultrasoundmentioning

confidence: 99%

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

Lee,

Sweetnam-Holmes,

Soffer

et al. 2024

Current Opinion in Pediatrics

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Pediatric Blunt Abdominal Trauma Evaluation and Management Pathways

Ochoa

Streck

2023

Curr Trauma Rep

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Validation of Prediction Rules for Computed Tomography Use in Children With Blunt Abdominal or Blunt Head Trauma: Protocol for a Prospective Multicenter Observational Cohort Study

Ugalde¹,

Chaudhari²,

Badawy³

et al. 2022

JMIR Res Protoc

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Background Traumatic brain injuries (TBIs) and intra-abdominal injuries (IAIs) are 2 leading causes of traumatic death and disability in children. To avoid missed or delayed diagnoses leading to increased morbidity, computed tomography (CT) is used liberally. However, the overuse of CT leads to inefficient care and radiation-induced malignancies. Therefore, to maximize precision and minimize the overuse of CT, the Pediatric Emergency Care Applied Research Network (PECARN) previously derived clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma in large cohorts of children who are injured. Objective This study aimed to validate the IAI and age-based TBI clinical prediction rules for identifying children at high risk and very low risk for IAIs undergoing acute intervention and clinically important TBIs after blunt trauma. Methods This was a prospective 6-center observational study of children aged <18 years with blunt torso or head trauma. Consistent with the original derivation studies, enrolled children underwent routine history and physical examinations, and the treating clinicians completed case report forms prior to knowledge of CT results (if performed). Medical records were reviewed to determine clinical courses and outcomes for all patients, and for those who were discharged from the emergency department, a follow-up survey via a telephone call or SMS text message was performed to identify any patients with missed IAIs or TBIs. The primary outcomes were IAI undergoing acute intervention (therapeutic laparotomy, angiographic embolization, blood transfusion, or intravenous fluid for ≥2 days for pancreatic or gastrointestinal injuries) and clinically important TBI (death from TBI, neurosurgical procedure, intubation for >24 hours for TBI, or hospital admission of ≥2 nights due to a TBI on CT). Prediction rule accuracy was assessed by measuring rule classification performance, using standard point and 95% CI estimates of the operational characteristics of each prediction rule (sensitivity, specificity, positive and negative predictive values, and diagnostic likelihood ratios). Results The project was funded in 2016, and enrollment was completed on September 1, 2021. Data analyses are expected to be completed by December 2022, and the primary study results are expected to be submitted for publication in 2023. Conclusions This study will attempt to validate previously derived clinical prediction rules to accurately identify children at high and very low risk for clinically important IAIs and TBIs. Assuming successful validation, widespread implementation is then indicated, which will optimize the care of children who are injured by better aligning CT use with need. International Registered Report Identifier (IRRID) RR1-10.2196/43027

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External validation of a pediatric decision rule for blunt abdominal trauma

Cited by 4 publications

References 23 publications

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

Updates on the clinical integration of point-of-care ultrasound in pediatric emergency medicine

Pediatric Blunt Abdominal Trauma Evaluation and Management Pathways

Validation of Prediction Rules for Computed Tomography Use in Children With Blunt Abdominal or Blunt Head Trauma: Protocol for a Prospective Multicenter Observational Cohort Study

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