Clinical Decision Rule to Identify Children with Intra-Abdominal Injuries

识别腹内损伤儿童的临床决策规则

• 批准号: 7183897
• 负责人: James F. Holmes
• 金额: $ 43.13万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2009-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7183897
• 关键词: cancer risk; children; clinical research; computed axial tomography; diagnosis procedure safety; disease /disorder proneness /risk; emergency care; gastrointestinal disorder diagnosis; human subject; injury; medical complication; patient care management; patient oriented research; pediatrics; radiation related neoplasm /cancer; trauma

Trauma is the leading cause of death in children and intra-abdominal injuries (IAI) are a frequent cause of morbidity and mortality due to trauma. Some IAIs are difficult to identify and failure to identify these injuries results in preventable morbidity and mortality. Abdominal computerized tomography (CT) is the reference standard for the diagnosis of IAl. CT scanning, however, has important risks, primarily the risk of development of radiation-induced malignancy. For every 1,500 children undergoing abdominal CT scanning, approximately one child will die from a malignancy induced by the radiation and up to three additional children will develop non-fatal malignancies from this exposure. Only approximately 10% of abdominal CT scans currently performed on children with trauma demonstrate IAIs, thus CT scanning is used inefficiently. Objectives: The objective of this study is to develop highly sensitive, specific and generalizable decision rules for the evaluation of children seen in emergency departments (EDs) with blunt abdominal trauma. These decision rules may then serve to generate evidence-driven guidelines for the evaluation of these children, and when implemented will result in more efficient use of CT scans. Study Design: This will be a prospective, multicenter, observational study of children with blunt abdominal trauma. Setting: Children with blunt abdominal trauma seen at one of 17 hospitals in the Pediatric Emergency Care Applied Research Network (PECARN) will be enrolled over a two year period. The EDs of the PECARN evaluate more than 900,000 children of diverse geographic and racial/ethnic background annually. Participants: We will enroll approximately 9,774 children with significant blunt torso trauma, including 900 children with IAl. Outcome Measures: The primary outcome for this study will be IAI in need of acute intervention (IAI resulting in death, or an IAI in need of any of the following: laparotomy, blood transfusion, angiographic embolization, or IV hydration). Interventions/Data analysis: The patients' history, physical examination findings and laboratory results at ED evaluation will be analyzed using recursive partitioning to generate a clinical decision rule(s) for the identification of children at high risk and near-zero risk of IAI in need of acute intervention. The decision rule (s) will lead to more efficient use of abdominal CT in those children at risk for IAIs, and a decrease in use in those at near-zero risk of IAI, ultimately resulting in more efficient, safe and effective care of injured children.

外伤是儿童死亡的主要原因，腹内损伤 (IAI) 是常见的情况 外伤引起的发病和死亡的原因。一些 IAI 很难识别并且无法识别这些 伤害导致可预防的发病率和死亡率。腹部计算机断层扫描（CT）是 IAl诊断的参考标准然而，CT 扫描具有重大风险，主要是以下风险： 辐射诱发的恶性肿瘤的发展。每 1,500 名接受腹部 CT 扫描的儿童中， 大约一名儿童将死于辐射诱发的恶性肿瘤，另外最多还有三名儿童 儿童将因这种接触而患上非致命性恶性肿瘤。目前对创伤儿童进行的腹部 CT 扫描中只有约 10% 表现出 IAI，因此 CT 扫描的使用效率低下。目标： 本研究的目的是为 对在急诊科 (ED) 就诊的腹部钝性创伤儿童进行评估。这些决定 然后，规则可以用于生成评估这些儿童的证据驱动指南，并且何时 实施将提高 CT 扫描的使用效率。研究设计：这将是一个前瞻性的、 针对腹部钝性创伤儿童的多中心观察性研究。环境： 孩子性格迟钝 儿科紧急护理应用研究网络 17 家医院之一发现腹部外伤 (PECARN) 将在两年内注册。 PECARN 的 ED 评估超过 900,000 每年都有不同地理和种族/民族背景的儿童。参与者：我们将报名约 9,774 名 患有严重躯干钝挫伤的儿童，其中包括 900 名患有 IAl 的​​儿童。结果衡量标准：主要 本研究的结果将是需要紧急干预的 IAI（IAI 导致死亡，或 IAI 需要任何 以下措施：剖腹手术、输血、血管造影栓塞或静脉补液）。 干预/数据分析：患者的病史、体检结果和急诊室的实验室结果 将使用递归分区来分析评估，以生成临床决策规则 识别需要紧急干预的 IAI 高风险和接近零风险的儿童。决策规则 (s) 将导致那些有 IAI 风险的儿童更有效地使用腹部 CT，并减少 那些 IAI 风险几乎为零的人，最终为受伤儿童提供更高效、安全和有效的护理。