Category: Gastrointestional
Keywords: PECARN, abdomen, clinical decision making (PubMed Search)
Posted: 8/13/2025 by Neeraja Murali, DO, MPH
(Updated: 12/5/2025)
Click here to contact Neeraja Murali, DO, MPH
Most of us are probably familiar with the PECARN Algorithm for neuroimaging in pediatric head trauma. But fewer people are familiar with the PECARN Pediatric Intra-Abdominal Injury (IAI) Algorithm.
Inclusion criteria can be found in the original study, referenced below
The original study collected data from 20 studies, and found that CT imaging can be avoided (ie patients are at very low risk for IAI) if the following criteria are met:
-No visible abdominal wall trauma or seatbelt sign
-GCS > 13
-No abdominal tenderness
-No thoracic wall trauma
-No abdominal pain
-No decreased breath sounds
-No vomiting
In the original cohort, 42% of study participants met all of these criteria and the risk of IAI requiring intervention was 0.1%
This study has been validated multiple times since its introduction in 2012, with the most recent being a multicenter study published in the Lancet in 2024. This recent study looked at 7542 children with blunt abdominal trauma, and the IAI rule was fond to have a sensitivity of 100% (95% CI 98-100%) and a negative predictive value (NPV) of 100% (95% CI 99.9-100%).
I know, it seems too good to be true…but the takeaway is that these clinical decision making rules can be more reliable than clinical gestalt in the appropriate patient population.
Holmes JF, Lillis K, Monroe D, et al. Identifying children at very low risk of clinically important blunt abdominal injuries. Ann Emerg Med. 2013;62(2):107-116.e2. doi:10.1016/j.annemergmed.2012.11.009
Holmes JF, Yen K, Ugalde IT, et al. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health. 2024;8(5):339-347. doi:10.1016/S2352-4642(24)00029-4
Algorithm: https://www.mdcalc.com/calc/3971/pecarn-pediatric-intra-abdominal-injury-iai-algorithm
