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

项目总结/摘要 腹腔内损伤（IAI）和创伤性脑损伤（TBI）是儿童死亡的两大主要原因 1岁以上。一些IAI和TBI很难识别，如果无法识别这些损伤， 可预防的发病率和死亡率。腹部和头部计算机断层扫描（CT）扫描有 成为诊断IAI和TBI的参考标准，CT的使用在2009年显著增加。 过去30年然而，CT扫描具有重要的风险，特别是辐射诱发恶性肿瘤的风险。 辐射诱发的幼儿恶性肿瘤的风险约为400分之一的腹部CT扫描 每1,200次头颅CT扫描中就有一次目前，只有不到10%的腹部和头颅CT扫描， 受伤的儿童表现为IAI或TBI，因此CT扫描的使用效率低下。这种低效率主要是 由于医生担心遗漏损伤以及缺乏关于CT适应症的严格证据， 创伤后使用。我们以前已经推导出使用腹部或头颅CT的临床决策规则 扫描受伤儿童。这些规则是在大规模、多样化、多中心人群中得出的，并且是稳健的 然而，这些规则尚未在大型多中心环境中进行外部验证。 在临床实施之前，需要对衍生的临床决策规则进行适当验证。等 验证应在大型、多样化、多中心人群中进行。本研究的目标 是为了验证这些先前推导出的，高度准确的腹部和颅骨的一般决策规则， 外伤儿童的CT扫描。一旦得到验证，这些决策规则将为以下方面提供证据： 正确使用CT检查受伤儿童。我们还将收集关于CT在儿童中使用的数据， 根据决策规则，IAI或TBI的风险较低。这些信息将被用于帮助执行规则。 这些规则的实施将允许及时识别需要治疗的IAI或TBI儿童。 因此，在儿童中避免CT扫描，这种伤害的风险最小。这项研究将是一项 一项对钝性腹部或头部创伤儿童的前瞻性、多中心观察性验证研究 国家CTSA急诊护理转化研究合作组织中的六个急诊部门 （ECTRC）。该联盟的急诊部门评估了30多万名不同疾病的儿童， 种族和民族背景。7,500多名儿童钝性腹部和2万名儿童 钝性头部创伤患者将在参与中心入组3年半以上。中的变量 将在CT扫描之前收集先前导出的决策规则， 可以以无偏的方式执行。这些规则的成功验证将使 将这些规则纳入临床护理，并改善美国各地受伤儿童的护理。

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.