BCMS Medical Record Fall 2020 - 34

Student Summer Research Projects
continued from page 31

Validity of PECARN Clinical
Prediction Tool in Non-Pediatric
Community Hospitals
by McKenna Brower, Syracuse University, Student
Research Intern; Alexis Schoener, The Pennsylvania
State University, Student Research Intern; Adam Sigal,
MD, Department of Emergency Medicine, Reading
Hospital, Reading, Pennsylvania; Christopher Valente,
MD, Department of Emergency Medicine, Reading
Hospital, Reading, Pennsylvania; Adrian Ong, MD,
Department of Emergency Medicine, Reading Hospital,
Reading, Pennsylvania; Samuel Wood, DO, Department
of Emergency Medicine, Reading Hospital, Reading,
Pennsylvania; Elizabeth Mannarelli, DO, Department
of Emergency Medicine, Reading Hospital, Reading,
Pennsylvania; Anthony Martin, BSNN, TCRN,
Department of Emergency Medicine, Reading Hospital,
Reading, Pennsylvania; Camilla Nettleton, BSN, RN,
Traci Deaner, MSN, RN, Department of Emergency
Medicine, Reading Hospital, Reading, Pennsylvania;
Alison Muller, MLS (ASCP), MSPH, Department
of Emergency Medicine, Reading Hospital, Reading,
Pennsylvania

INTRODUCTION: Abdominal injuries can lead to extreme
medical complications and even death, especially in children1.
It is therefore essential to establish the presence of an abdominal
injury as quickly as possible to minimize health risks to the
patient. While computed tomography2, or CT scans, are helpful
in providing imaging, one downfall to CT imaging is high
radiation exposure. This radiation exposure can be especially
harmful in children, which is why the PECARN Clinical
Prediction Rule was developed. PECARN stands for Pediatric
Emergency Care Applied Research Network3. This tool lists seven
pieces of criteria which include: evidence of abdominal wall
trauma or seat belt sign, a Glasgow Coma Score (GCS) score less
than or equal to 13, evidence of abdominal tenderness, evidence
of thoracic wall trauma, complaints of abdominal pain, decreased
breath sounds, and vomiting4. If one of these seven criteria apply
to a patient, the PECARN is automatically positive. When the
PECARN is positive, this indicates that an abdominal CT scan
should be done, but of course clinical judgement should also be
taken into consideration. PECARN can only be negative if all
seven pieces of evidence are not present. It is also possible for
PECARN to be unable to be determined and this occurs when
any of the seven criteria are not able to be assessed. The overall
aims of this study are to determine if the set of rules established

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by PECARN are valid, to determine the percentage of unnecessary
CT scans performed, and determine the percentage of missed intraabdominal injuries all within a non-pediatric community hospital.
METHODS: A total of 874 charts were included in this retrospective
chart review that ranged from February 2013 to December 2019.
The patients that were enrolled in this study were all patients under
the age of eighteen that were seen in the Reading Hospital Pediatric
Emergency Department, the Emergency Department, or the Trauma
Bay due to a blunt abdominal trauma.
The information was obtained through EPIC and was recorded
in REDCap5,6. Criteria that indicates either a positive or negative
PECARN was searched for in every chart to determine if unnecessary
CT scans were performed or if abdominal injuries would have been
missed by solely using the PECARN prediction tool.
RESULTS: While the PECARN project is not fully complete, there
was preliminary data that was compiled based on the trends that
were noticed. Out of the 651 completed charts, 102 (15.67%) of
those charts were missing either one or numerous pieces of evidence
needed, and therefore PECARN was unable to be determined.
Additionally, results showed that in 104 cases (15.98%) that were
PECARN negative, patients still had a CT performed. Furthermore,
it was found that in 86 cases (13.21%) patients had a positive
PECARN but did not receive a CT scan. The last statistic calculated
was looking to answer how many unnecessary CT scans were
completed and how many injuries would have been missed by solely
using the PECARN rules. Out of 104 cases that had a negative
PECARN but did receive a CT scan, 83 cases (79.81%) had negative
CT findings while 21 cases (20.19%) had positive CT results.
CONCLUSION: Although the study is not yet complete and still
ongoing, preliminary data indicates that unnecessary CT scans
were being ordered; however; abdominal injuries would also have
been missed if only the PECARN rules were followed. The data also
showcased major trends which include inefficient charting and CT
scans being ordered even with a negative PECARN.
Charting inefficiency and missing information are concerns and
can lead to issues since it does not allow for PECARN to be ruled
as positive or negative. The statistics supported this claim that
inefficient charting is a prevalent issue and going forward an effort
should be made to ensure all of the criteria are properly documented.
Another noticeable trend showed that CT imaging was still being
ordered despite the PECARN being negative. This is going to be
important to analyze and going forward, it will be essential to
determine how many injuries would have been missed by only
using PECARN so that the validity of this tool can be established.
The last crucial statistics that were calculated showed that within
the PECARN negative cases that still received a CT scan, patients
actually had positive scans. So, while it could be argued that the
majority of the CT scans ordered were unnecessary, there also would
have been injuries missed.


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