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PECARN Pediatric Intra-Abdominal Injury (IAI) Algorithm
Identifies children at very low risk of clinically important blunt intra-abdominal injury.
PECARN Pediatric Intra-Abdominal Injury (IAI) Algorithm
Evidence of abdominal wall trauma or seatbelt sign
GCS <14
Abdominal tenderness
Evidence of thoracic wall trauma
Complaints of abdominal pain
Decreased breath sounds
Vomiting
Result0 predictors present
All 7 predictors absent: very low risk (~0.1%) of intra-abdominal injury undergoing acute intervention. CT for intra-abdominal injury is often unnecessary based on this rule alone.
- Predictors present
- 0
- Risk category
- Very low risk
When to use
- Children with blunt torso trauma, to identify those at very low risk of intra-abdominal injury undergoing acute intervention, for whom CT can often be safely avoided.
Formula
The rule is negative (very low risk) only when ALL 7 findings are absent: abdominal wall trauma/seatbelt sign, GCS <14, abdominal tenderness, thoracic wall trauma, complaints of abdominal pain, decreased breath sounds, and vomiting. Any one finding present removes the child from the very-low-risk group.
Pearls and pitfalls
- In the validation cohort, absence of all 7 findings carried a negative predictive value of 99.9% and sensitivity of 97% for intra-abdominal injury undergoing acute intervention.
- A negative rule does not exclude all intra-abdominal injury, only injury severe enough to require acute intervention (e.g., laparotomy, angiographic embolisation, blood transfusion for abdominal injury).