Validation of Decision Rules for CT Use in Children with Abdominal or Head Trauma

腹部或头部创伤儿童 CT 使用决策规则的验证

• 批准号: 9177011
• 负责人: James F. Holmes
• 金额: $ 70.13万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-15 至 2021-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9177011
• 关键词: 1 year old; Abdomen; Abdominal Injuries; Accident and Emergency department; Acute; Adult; Applied Research; Behavior; Blunt Trauma; Brain; Brain Injuries; Brain Neoplasms; Caring; Cause of Death; Cephalic; Cessation of life; Characteristics; Child; Childhood; Childhood Injury; Childhood Leukemia; Clinical; Collaborations; Consensus; Craniocerebral Trauma; Data; Derivation procedure; Development; Diagnosis; Diagnostic tests; Emergency Care; Emergency medical service; Enrollment; Evaluation; Failure; Frequencies; Health Resources; Health Services Administration; Image; Infant; Injury; Intervention; Intra-abdominal; Malignant Neoplasms; Methods; Morbidity - disease rate; Organ; Patient risk; Patients; Phase; Physicians; Population; Predictive Value; Quality of Care; Radiation; Reference Standards; Research; Risk; Risk Factors; Scanning; Symptoms; System; Testing; Translational Research; Trauma; Traumatic Brain Injury; United States; Validation; X-Ray Computed Tomography; base; clinical care; cohort; improved; injured; minimal risk; mortality; programs; prospective; racial and ethnic; support tools; validation studies

PROJECT SUMMARY/ABSTRACT Intra-abdominal injury (IAI) and traumatic brain injury (TBI) are the two leading causes of death in children older than 1 year. Some IAIs and TBIs are difficult to identify, and failure to identify these injuries results in preventable morbidity and mortality. Abdominal and cranial computerized tomography (CT) scanning have become the reference standard for diagnosing IAI and TBI, and CT use has significantly increased over the last 30 years. CT scanning, however, has important risks, particularly the risk of radiation-induced malignancy. The risk of radiation-induced malignancy in young children is approximately one in 400 abdominal CT scans and one in 1,200 cranial CT scans. Currently, fewer than 10% of abdominal and cranial CT scans obtained in injured children demonstrate IAI or TBI, thus, CT scanning is used inefficiently. This inefficiency is primarily driven by physician concerns of missing injuries and the lack of rigorous evidence regarding indications for CT use after trauma. We have previously derived clinical decision rules for the use of abdominal or cranial CT scanning in injured children. These rules were derived in large, diverse, multicenter populations, and are robust and precise; however, these rules have not yet been externally validated in a large, multicenter setting. Appropriate validation of derived clinical decision rules is required before clinical implementation. Such validation should be performed in a large, diverse, multicenter population. The objectives of the current study are to validate these previously derived, highly accurate generalizable decision rules for abdominal and cranial CT scanning in injured children. Once validated, these decision rules will then provide the evidence for appropriate use of CT in injured children. We will additionally collect data on CT use in children who are very low risk for IAI or TBI by the decision rules. This information will then be used to assist in rule implementation. Implementation of these rules will allow for timely identification of children with IAI or TBI in need of intervention, while avoiding CT scanning in children with minimal risk of such injuries. The study will be a prospective, multicenter observational validation study of children with blunt abdominal or head trauma at one of six emergency departments in the national CTSA Emergency Care Translational Research Collaborative (ECTRC). The emergency departments of this consortium evaluate more than 300,000 children of diverse racial and ethnic backgrounds every year. More than 7,500 children with blunt abdominal and 20,000 children with blunt head trauma will be enrolled over 3 ½ years at the participating centers. The variables in the previously derived decision rules will be collected prior to CT scanning such that validation of the decision rules can be performed in an unbiased fashion. Successful validation of these rules will enable implementation of the rules into clinical care and improve the care of injured children across the United States.

项目概要/摘要 腹内损伤（IAI）和创伤性脑损伤（TBI）是儿童死亡的两个主要原因 1 岁以上。有些 IAI 和 TBI 很难识别，未能识别这些损伤会导致 可预防的发病率和死亡率。腹部和颅骨计算机断层扫描 (CT) 扫描 成为诊断 IAI 和 TBI 的参考标准，CT 的使用在过去几年中显着增加 过去30年。然而，CT 扫描具有重大风险，特别是辐射诱发恶性肿瘤的风险。 幼儿患辐射诱发恶性肿瘤的风险约为 400 次腹部 CT 扫描中的 1 次 1,200 次颅脑 CT 扫描中就有 1 次。目前，只有不到 10% 的腹部和颅骨 CT 扫描是在 受伤儿童表现出 IAI 或 TBI，因此 CT 扫描的使用效率较低。这种低效率主要是 由于医生担心缺少损伤以及缺乏关于 CT 指征的严格证据 外伤后使用。我们之前已经得出了使用腹部或颅部 CT 的临床决策规则 对受伤儿童进行扫描。这些规则是在大量、多样化、多中心人群中得出的，并且是稳健的 且精确；然而，这些规则尚未在大型多中心环境中得到外部验证。 在临床实施之前需要对衍生的临床决策规则进行适当的验证。这样的 验证应在大量、多样化、多中心人群中进行。当前研究的目标 验证这些先前导出的、高度准确的腹部和颅骨通用决策规则 受伤儿童的 CT 扫描。一旦经过验证，这些决策规则将为 受伤儿童适当使用 CT。我们还将额外收集关于病情严重的儿童使用 CT 的数据。 根据决策规则，IAI 或 TBI 的风险较低。然后，该信息将用于协助规则的实施。 这些规则的实施将有助于及时识别需要治疗的 IAI 或 TBI 儿童 干预，同时避免对此类伤害风险最小的儿童进行 CT 扫描。该研究将是一个 一项针对腹部或头部钝挫伤儿童的前瞻性、多中心观察性验证研究 国家 CTSA 紧急护理转化研究合作组织的六个急诊科 （ECTRC）。该联盟的急诊部门对超过 300,000 名不同背景的儿童进行了评估 每年都有种族和民族背景。 7,500多名腹部钝痛儿童和20,000名儿童 患有钝性头部外伤的患者将在参与中心注册超过 3.5 年。中的变量 在 CT 扫描之前将收集先前导出的决策规则，以便验证决策规则 可以以公正的方式执行。这些规则的成功验证将有助于实施 将规则纳入临床护理并改善美国各地受伤儿童的护理。