BCMS Medical Record Fall 2020 - 37

INTRODUCTION: The Pediatric Emergency Care Applied Research
Network (PECARN) Clinical Prediction Tool is used to assess
blunt abdominal trauma in pediatric patients.1 Through a review of
symptoms and a physical exam the PECARN rule can be applied.
Proper utilization of the PECARN rule can assist in determining if
pediatric patients meet the criteria for CT imaging.
The rules in the PECARN prediction include: evidence of abdominal
wall trauma or seat belt sign, Glasgow Coma Score (GCS) score less
than or equal to 13, abdominal tenderness, evidence of thoracic wall
trauma, complaints of abdominal pain, decreased breath sounds,
and vomiting.1 In conjunction with clinical judgement, if any of the
seven criteria in the PECARN rule is met a CT should be ordered.
The goals of the PECARN study are to determine the validity
of the rules in non-pediatric community hospitals, determine if
unnecessary CT imaging is being ordered, and to determine the
amount of missed abdominal injuries.
METHODS: A retrospective chart study was completed from
February 1, 2013 through December 31, 2019 on pediatric trauma
patients seen at the Reading Hospital. The PECARN rules were
applied to the charts to determine its effectiveness on patients
evaluated during that time frame. The charts were viewed through
Epic, and the data was recorded in REDCap.2,3
RESULTS: Preliminary results show in 651 charts 15.67% of the
PECARN rulings were unable to be determined. In addition to the
48.69% that were negative and the 35.64% that were positive. A
negative PECARN paired with clinical judgement provides evidence
that a CT is not necessary, but 15.98% of patients with a negative
PECARN received a CT. Only 32.72% of patients care strictly
followed the PECARN rule and did not receive a CT when their
PECARN was negative.
This study produced a finding that 13.21% of patients had a positive
PECARN and did not receive a CT despite the PECARN indicating
otherwise. Statistics from this study yielded 79.81% of patients
had a negative PECARN, had a CT performed, but the CT results
showed no evidence of any abdominal injuries. 20.19% of patients
had a negative PECARN, and had a CT performed that did show
CONCLUSION: A few trends were noticed before any of the
preliminary results were considered. For example, the utilization
of CT imaging when the PECARN was negative, as well as the
inability to determine if the PECARN was positive or negative due
to charting inefficiencies.
Upon review of the preliminary results, the following conclusions
were obtained. If any of the seven criteria are not charted the
PECARN is unable to be determined. This does not allow for a clear
decision to be made about CT imaging. A flow sheet or checklist in
Epic would increase the accuracy of medical records.

unnecessary CT scans. There was also evidence that abdominal
injuries would have been missed if only the PECARN rules were
followed.
The results appear to indicate that physicians are more likely to take
the risk in exposing their patients to some amount of radiation than
potentially miss an abdominal injury. Until the PECARN Clinical
Prediction Tool is made standard in non-pediatric community
hospitals, unnecessary CT imaging, the potential to miss an
abdominal injury, and the possibility of inadequate charting will
continue. Making the PECARN Clinical Prediction Tool a standard
would hopefully ensure the seven criteria is always charted, and
all physicians would use the same decision-making process when
determining if a CT is necessary or not.
A future retrospective chart study should be completed to determine
the validity of the PECARN Clinical Prediction Tool in nonpediatric community hospitals after a flow sheet or checklist is
implemented. This would allow future researchers to solely observe
the PECARN positive and negative data and make conclusions
without the hinderance of inaccurate charting.
Alexis Schoener is scheduled to graduate from The
Pennsylvania State University - Berks in 2021 with a B.S.
in Science. She is a member of the Women's Soccer Team,
serves as a volunteer General Chemistry Teaching Assistant
and a Habilitation Coordinator for Abilities in Motion,
among other activities.

1
James Holmes et al., Identifying Emergency Care Applied Research
Network (PECARN). (2013, August). Identifying Children at
Very Low Risk of Clinically Important Blunt Abdominal Injuries.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23375510.

PA Harris, R Taylor, R Thielke, J Payne, N Gonzalez, JG. Conde,
Research electronic data capture (REDCap) - A metadata-driven
methodology and workflow process for providing translational
research informatics support, J Biomed Inform. 2009 Apr;42(2):37781.
2

PA Harris, R Taylor, BL Minor, V Elliott, M Fernandez, L O'Neal,
L McLeod, G Delacqua, F Delacqua, J Kirby, SN Duda, REDCap
Consortium, The REDCap consortium: Building an international
community of software partners, J Biomed Inform. 2019 May 9 [doi:
10.1016/j.jbi.2019.103208]
3

continued on next page >

Unnecessary CT scans and missed abdominal injuries are some
of the concerns being evaluated. CT imaging exposes patients to
radiation which can cause adverse events like oncologic diseases.
Findings from this study were consistent that patients are receiving

FALL 2020

|

37


http://www.ncbi.nlm.nih.gov/pubmed/23375510

BCMS Medical Record Fall 2020

Table of Contents for the Digital Edition of BCMS Medical Record Fall 2020

BCMS Medical Record Fall 2020 - 1
BCMS Medical Record Fall 2020 - 2
BCMS Medical Record Fall 2020 - 3
BCMS Medical Record Fall 2020 - 4
BCMS Medical Record Fall 2020 - 5
BCMS Medical Record Fall 2020 - 6
BCMS Medical Record Fall 2020 - 7
BCMS Medical Record Fall 2020 - 8
BCMS Medical Record Fall 2020 - 9
BCMS Medical Record Fall 2020 - 10
BCMS Medical Record Fall 2020 - 11
BCMS Medical Record Fall 2020 - 12
BCMS Medical Record Fall 2020 - 13
BCMS Medical Record Fall 2020 - 14
BCMS Medical Record Fall 2020 - 15
BCMS Medical Record Fall 2020 - 16
BCMS Medical Record Fall 2020 - 17
BCMS Medical Record Fall 2020 - 18
BCMS Medical Record Fall 2020 - 19
BCMS Medical Record Fall 2020 - 20
BCMS Medical Record Fall 2020 - 21
BCMS Medical Record Fall 2020 - 22
BCMS Medical Record Fall 2020 - 23
BCMS Medical Record Fall 2020 - 24
BCMS Medical Record Fall 2020 - 25
BCMS Medical Record Fall 2020 - 26
BCMS Medical Record Fall 2020 - 27
BCMS Medical Record Fall 2020 - 28
BCMS Medical Record Fall 2020 - 29
BCMS Medical Record Fall 2020 - 30
BCMS Medical Record Fall 2020 - 31
BCMS Medical Record Fall 2020 - 32
BCMS Medical Record Fall 2020 - 33
BCMS Medical Record Fall 2020 - 34
BCMS Medical Record Fall 2020 - 35
BCMS Medical Record Fall 2020 - 36
BCMS Medical Record Fall 2020 - 37
BCMS Medical Record Fall 2020 - 38
BCMS Medical Record Fall 2020 - 39
BCMS Medical Record Fall 2020 - 40
BCMS Medical Record Fall 2020 - 41
BCMS Medical Record Fall 2020 - 42
BCMS Medical Record Fall 2020 - 43
BCMS Medical Record Fall 2020 - 44
BCMS Medical Record Fall 2020 - 45
BCMS Medical Record Fall 2020 - 46
BCMS Medical Record Fall 2020 - 47
BCMS Medical Record Fall 2020 - 48
BCMS Medical Record Fall 2020 - 49
BCMS Medical Record Fall 2020 - 50
BCMS Medical Record Fall 2020 - 51
BCMS Medical Record Fall 2020 - 52
BCMS Medical Record Fall 2020 - 53
BCMS Medical Record Fall 2020 - 54
BCMS Medical Record Fall 2020 - 55
BCMS Medical Record Fall 2020 - 56
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Fall2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Spring2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Winter2021
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BCMS_MedicalRecord_Fall2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Spring2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Winter2020
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Fall2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksMedicalSocietyHealthWellnessDirectory
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksMedicalRecord_Spring2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksMedicalRecord_Winter2019
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Fall2018
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2018
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Spring2018b
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Winter2017-18
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_Physician_Fall2017
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/BerksCountyMedicalSociety_MedicalRecord_Summer2017
https://www.nxtbook.com/hoffmann/BerksCountyMedicalSociety/MedicalRecordSpring2017
https://www.nxtbookmedia.com