External Validation of a 5-Variable Clinical Prediction Rule for Identifying Children at Very Low Risk for Intra-Abdominal Injury Following Blunt Abdominal Trauma

Background A clinical prediction rule was previously developed by the Pediatric Surgery Research Collaborative (PedSRC) to identify patients at very low risk for intra-abdominal injury (IAI) and intra-abdominal injury receiving an acute intervention (IAI-I) who could safely avoid abdominal computed tomography (CT) scans following blunt abdominal trauma (BAT). Our objective was to externally validate the rule. Methods The public use dataset was obtained from the Pediatric Emergency Care Applied Research Network (PECARN) Intra-abdominal Injury Study. Patients 16 years of age and younger with chest x-ray, completed abdominal history and physical exam, aspartate aminotransferase (AST), and amylase or lipase collected within 6 hours of arrival were included. We excluded patients who presented greater than 6 hours after injury or missing any of the five clinical prediction variables from the PedSRC prediction rule. Results We included 2,435 patients from the PECARN dataset, with a mean age of 9.4 years. There were 235 patients with IAI (9.7%) and 60 patients with IAI-I (2.5%). The clinical prediction rule had a sensitivity of 97.5% for IAI and 100% for IAI-I. In patients with no abnormality in any of the five prediction rule variables, the rule had a negative predictive value of 99.3% for IAI and 100.0% for IAI-I. Of the “very low-risk” patients identified by the rule, 46.8% underwent abdominal CT imaging. Conclusions A highly-sensitive clinical prediction rule using history and abdominal physical examination, laboratory values, and chest x-ray was successfully validated using a large public access dataset of pediatric BAT patients. Level of Evidence Epidemiologic/Prognostic Study, Level III; Therapeutic Care/Management Study, Level IV Presented at the 31st Annual Meeting of the Eastern Association for the Surgery of Trauma, January 9-13, 2018 in Lake Buena Vista, FL. The authors have no financial disclosures or conflicts of interest © 2018 Lippincott Williams & Wilkins, Inc.

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