Validation of the PECARN Abdominal Rule and FAST-AST/ALT Criteria in Pediatric Blunt Abdominal Trauma: A Retrospective Cohort Study.

Aims: Rapid and accurate diagnosis of intra-abdominal injuries (IAIs) is crucial for pediatric patients with blunt abdominal trauma. However, clinical assessments can be challenging in children. We evaluated several clinical decision instruments (CDIs) designed to identify children with low risk of IAI who required acute intervention (IAI-I) at a Japanese pediatric hospital. Methods: This retrospective cohort study was conducted between April 2021 and March 2024 and included 259 pediatric patients with torso trauma. We used clinical and imaging data to compare the Pediatric Emergency Care Applied Research Network (PECARN) abdominal rule with a combination of focused assessment with sonography in trauma (FAST) with elevated aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels rule. Results: Of the 259 pediatric patients assessed, 20 (7.7%) developed IAI. Of these, one required intervention. The PECARN abdominal rule had a sensitivity of 100% and a specificity of 65.1% for identifying IAI-I, whereas FAST with elevated AST/ALT had a sensitivity of 100% and a specificity of 82.2%. For IAI, the PECARN abdominal rule had a sensitivity of 90% and a specificity of 69.5%, whereas FAST with elevated AST/ALT had a sensitivity of 65.0% and a specificity of 88.7%. Conclusions: The PECARN abdominal rule had high sensitivity but moderate specificity for identifying IAI, whereas FAST with elevated AST/ALT had a higher specificity. These findings suggest that CDIs can minimize unnecessary computed tomography scans in this context. Further validation of these findings in other healthcare settings and patient populations is warranted.