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

项目摘要/摘要 腹内损伤(IAI)和创伤性脑损伤(TBI)是导致儿童死亡的两大主要原因 年龄在1岁以上。一些IAI和TBI很难识别，而未能识别这些损伤会导致 可预防的发病率和死亡率。腹部和头颅CT扫描有 成为诊断IAI和TBI的参考标准，CT的使用在过去几年中显著增加 过去的30年里。然而，CT扫描有重要的风险，特别是辐射诱发的恶性风险。 幼儿因辐射致癌的风险约为400例腹部CT扫描中的1例 每1200例头颅CT扫描中就有一例。目前，只有不到10%的腹部和颅脑CT扫描是在 受伤的儿童表现为IAI或TBI，因此CT扫描的使用效率较低。这种低效主要是 由于医生对遗漏损伤的担忧，以及缺乏关于CT适应症的严格证据 创伤后使用。我们以前已经得出了使用腹部或头颅CT的临床决策规则 扫描受伤的儿童。这些规则是在庞大的、多样化的、多中心的人群中衍生出来的，并且是可靠的 和精确；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，需要对导出的临床决策规则进行适当的验证。是这样的 验证应在一个庞大、多样化、多中心的人群中进行。当前研究的目标 是为了验证这些先前派生的、高度准确的腹部和颅骨的可概括决策规则 受伤儿童的CT扫描。一旦得到验证，这些决策规则将为 CT在受伤儿童中的合理应用。我们还将收集有关CT在儿童中的使用情况的数据 根据决策规则，IAI或TBI的风险较低。然后，这些信息将被用来协助执行规则。 这些规则的实施将使及时识别患有IAI或TBI的儿童需要 干预措施，同时避免对此类伤害风险最小的儿童进行CT扫描。这项研究将是一个 儿童钝性腹部或头部创伤的前瞻性、多中心观察性验证研究 六个急诊科中的全国CTSA急救转化性研究协作 (ECTRC)。该联盟的急诊科评估了30多万名不同类型的儿童 每年都有种族和民族背景。7500多名儿童腹部钝器和2万名儿童 钝性头部创伤将在三年半内在参与中心登记。中的变量 将在CT扫描之前收集先前导出的决策规则，以便对决策规则进行验证 可以不偏不倚地执行。这些规则的成功验证将使 将规则引入临床护理，并改善全美受伤儿童的护理。

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.