PECARN Pediatric Intra-Abdominal Injury (IAI) Algorithm

• Should not be used to dictate whether a patient needs a CT or not; it is purely to identify patients at very low risk for an injury requiring acute intervention.

• The risk percentage estimated by this tool can aid in shared decision making between the patient, their family, and the treating clinician on whether to pursue imaging with ionizing radiation.

• For children, the lifetime risk of developing radiation-induced fatal cancer increases by up to 0.14% with each abdominal CT scan (Brenner and Hall 2007).

• The majority of patients with intra-abdominal injury intervention (IAI-I) misclassified as low risk had distracting injury or intoxication; consider a lower threshold to obtain CT in these cases if there is clinical suspicion despite being classified as low or very low risk for IAI-I.

• Patients deemed very low risk for intra-abdominal injury requiring acute intervention may avoid CT abdomen, unless clinical suspicion exists for significant intra-abdominal injury.

• Take into consideration the resources at hand as well as the patient’s ability to achieve close follow-up or easily return to the hospital when planning work-up and disposition.

• One or more positive predictors does not necessitate a CT scan. Other methods of imaging or laboratory work-up can assist in identifying IAI requiring intervention (e.g. FAST, liver enzymes, lipase, UA, or other forms of imaging based on clinical stability and resources available). Observation with serial abdominal exams may be an option in clinically stable patients. 

As always, use ABCs and intervene to stabilize the patient with blunt abdominal trauma before making decisions regarding imaging.