PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study

CT scans are frequently used in pediatric abdominal and head trauma, and many times overused exposing children to an unnecessary risk of radiation-induced malignancies. The article titled Per Current Prediction Rules of CT Imaging of Children presented to the emergency department with blunt abdominal or minor head trauma. A multi-center perspective validation study was published in The Lancet Child and Adolescent Health in May 2024. The authors asked themselves whether the Picard prediction rules accurately identify children at very low risk for serious injuries, thus reducing unnecessary CT scans in pediatric emergency departments. This prospective multi-center study enrolled 27,541 children under 18 years old who presented with blunt abdominal or minor head trauma across 6 US pediatric centers. The study evaluated the preclinical prediction tool before the decision of obtaining a CT admission, or any other intervention. The primary outcomes measured were intraabdominal injuries requiring acute intervention and clinically important traumatic brain injuries. The prec prediction rules demonstrated a sensitivity of 100% and a negative predictive value of 100% for identifying both. One limitation of the study is that the Precar rules were already known by the physicians applying them by previous retrospective studies, so they could have been already applying them. Implementing the Pecan prediction rules in prediatic emergency department could help clinicians avoid up to 25% of abdominal CT scans and 15% of brain CT scans, thereby reducing radiation exposure and improving the overall quality of care for children with blunt abdominal or minor head trauma.