PECARN Paediatric Intra-Abdominal Injury (IAI) After Blunt Torso Trauma
Validated clinical decision rule to identify children at very low risk of intra-abdominal injury requiring acute intervention following blunt torso trauma, potentially avoiding CT scanning.
Score interpretation
No PECARN IAI criteria present -- very low risk (< 0.1%) of significant intra-abdominal injury
→ CT abdomen NOT required based on PECARN IAI criteria; admit for 4-6 hours observation; serial abdominal examinations every 1-2 hours; clear fluid diet; repeat examination before discharge; if pain worsens or new symptoms develop, escalate to CT or surgical review; discharge if pain-free and eating and drinking with normal observations; written advice: return if abdominal pain worsens, fever, vomiting, inability to eat; GP follow-up in 24 hours; document PECARN IAI assessment in notes.
One or more PECARN IAI criteria present -- significant IAI possible
→ CT abdomen and pelvis with IV contrast (CECT) unless contraindicated; paediatric surgery consultation; if haemodynamically unstable: immediate surgical review -- may proceed directly to theatre without CT (FAST ultrasound if time permits); bloods: FBC, U+E, LFT (AST/ALT), amylase, lipase, coagulation, group and save; IV access x2; fluid resuscitation if needed; nil by mouth pending surgical review; analgesia IV (morphine 0.1 mg/kg); monitor: BP, HR, SpO2, urine output; document mechanism of injury; consider non-accidental injury (NAI) if mechanism inconsistent with injury pattern -- safeguarding referral if NAI suspected.
Interpretation bands for the PECARN IAI. Apply clinical judgement and local guidance.
References
- Holmes JF et al. Identification of children at very low risk of clinically-important blunt abdominal injuries. Ann Emerg Med. 2013;62(2):107-116.
- NICE NG39. Major trauma: service delivery. NICE. 2016.
Related
Curated clinical cross-links plus same-class fallbacks.
- Ertapenem · Carbapenem — ESBL / Complicated Intra-Abdominal / Community OPAT
- Tigecycline · Glycylcycline — MDR Gram-Negative / Polymicrobial / Complicated Intra-abdominal
- Ibuprofen (Paediatric) · NSAID / Analgesic / Antipyretic
- Paracetamol (Paediatric) · Analgesic / Antipyretic — First-Line Pain and Fever in Children
- Morphine (Paediatric) · Opioid Analgesic — Moderate to Severe Pain in Children
- Gentamicin (Paediatric) · Aminoglycoside — Neonatal Sepsis / Gram-Negative Infections in Children
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.