Clinical Decision Rule to Identify Children with Intra-Abdominal Injuries

创伤是儿童死亡的主要原因，腹内损伤(IAI)是常见的 创伤致病和致死的原因。有些IAI很难识别，也无法识别 伤害会导致可预防的发病率和死亡率。腹部计算机断层扫描(CT)是 诊断食管炎的参考标准。然而，CT扫描有重要的风险，主要是 辐射诱发的恶性肿瘤的发展。每1500名接受腹部CT扫描的儿童， 大约有一名儿童将死于辐射引发的恶性肿瘤，另有三名儿童将死亡。 儿童会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，只有大约10%显示出IAIS，因此CT扫描的使用效率很低。目标： 这项研究的目的是制定高度敏感、具体和可推广的决策规则 对在急诊科就诊的钝性腹部创伤儿童的评估。这些决定 然后，规则可以用来为这些儿童的评估以及何时产生证据驱动的指导方针 实施后，将更有效地使用CT扫描。研究设计：这将是一项前瞻性研究， 儿童钝性腹部创伤的多中心观察性研究。背景：钝器儿童 在儿科急救应用研究网络的17家医院之一看到的腹部创伤 (PECARN)将在两年内注册。PECARN的EDS评估了90多万 每年都有不同地理和种族/民族背景的儿童。参与者：我们将招收约9,774人 患有严重钝性躯干创伤的儿童，包括900名患有IAL的儿童。结果衡量标准：主要 这项研究的结果将是需要急性干预的IAI(IAI导致死亡，或需要任何 以下方法之一：剖腹、输血、血管造影栓塞术或静脉水化。 干预/数据分析：急诊科患者的病史、体检结果和实验室结果 评估将使用递归划分进行分析以生成临床决策规则(S) 确定需要急性干预的高危和近乎零风险的IAI儿童。决策规则 (S)将导致在那些有IAIS风险的儿童中更有效地使用腹部CT，并减少 这些儿童的IAI风险几乎为零，最终导致对受伤儿童的更有效、更安全和更有效的护理。

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.