Exam

PECARN Pediatric Intra-Abdominal Injury Algorithm

PECARN Pediatric Intra-Abdominal Injury Algorithm, PECARN Blunt Abdominal Trauma in Children Decision Rule, Pediatric Blunt Abdominal Trauma Decision Rule, Blunt Abdominal Trauma Decision Rule for Children

See Also

Indications

Pediatric Blunt Abdominal Trauma in prior 24 hours

Contraindications

Penetrating Trauma
Preexisting neurologic disorder interferes with reliable exam
Pregnancy
Transfer from another hospital where other diagnostics have been already performed (e.g. Abdominal CT)

Criteria
7 Risk Factors

Highest Risk Criteria (5.4% risk of requiring intervention)
1. Abdominal wall Trauma signs or Seatbelt Sign
2. Glasgow Coma Scale <14
Moderate Criteria (1.4% risk of requiring intervention)
1. Abdominal tenderness on exam
Other Criteria (0.7% risk of requiring intervention)
1. Thoracic wall Trauma
2. Complains of Abdominal Pain
3. Absent or decreased breath sounds
4. Vomiting

Interpretation

All 7 criteria negative
1. Very reassuring and unlikely to have intra-Abdominal Injury requiring intervention
2. CT Abdomen not indicated unless for other criteria
Any criteria positive
1. Does not exclude significant intraabdominal injury
2. Further evaluation required (e.g. imaging)

Efficacy

Based on prospective study with over 12,000 patients, of whom 1.3% had a significant Abdominal Injury requiring intervention
1. Study did not incorporate FAST Exam or labs in the decision rule (due to lack of standardization across study centers)
Efficacy in identifying intraabdominal injury
1. Test Sensitivity: 97% (higher than gestalt, which was 82.8%)
2. Test Specificity: 42.5% (lower than gestalt, which was 78.7%)
3. Negative Predictive Value: 99.9%
4. Borgialli (2014) Acad Emerg Med 21: 1240-8 [PubMed]

References