Hot off the press: Comparison of clinical suspicion versus a clinical prediction rule when evaluating children following blunt torso Trauma

Abstract

The study was a planned secondary analysis of the initial PECARN derivation study.4 Consecutive patients < 18 years old presenting to a participating emergency department (ED) following blunt torso trauma were included if clinicians specified an initial level of suspicion (<1, 1-5, 6-10, 11-50, or >50%) for IAI requiring acute intervention prior to the abdominal CT scan. Abdominal CT scans were obtained at the discretion of physicians in the ED. Clinician suspicion for IAIs was considered positive if the risk of this outcome was presumed to be =1%. Likewise, the patients were considered to be non-low risk for the clinical prediction instrument if any one of the seven variables in the instrument was present. Patients assigned a clinical suspicion of <1% or deemed low risk by the clinical prediction instrument were considered to be at very low risk for IAI requiring acute intervention (equivalent to a 0.1% risk of IAI in the derivation study). IAIs requiring acute intervention were defined as follows: death due to abdominal injury, surgical intervention, angiographic embolization due to bleeding, blood transfusion for anemia secondary to traumatic hemorrhage, or requiring intravenous fluids for two or more nights in patients with gastrointestinal injuries. The authors calculated and compared the test characteristics for both the prediction instrument and clinical suspicion (=1%) for predicting patients with a significant IAI requiring acute intervention.