• Paediatrics
• Child Health
• Emergency Care

Recently, two important papers on paediatric trauma were published by investigators from the Paediatric Emergency Care Applied Research Network (PECARN): a validation paper for the prediction rules for computed tomography (CT) imaging of children with minor head and blunt abdominal trauma1 and a prediction rule for cervical spine imaging of children with blunt neck trauma.2

Funded by the Health Resources and Services Administration of the US government for over two decades, PECARN is an emergency research collaboration of tertiary paediatric emergency departments in the US. One of the research areas for PECARN has been the development of prediction rules for traumatic injuries to optimise decision-making in radiographic imaging, particularly CT imaging and to reduce the risk of radiation-associated malignancies. The key questions the PECARN trauma rules set out to answer were how to identify children at low risks of the injuries of interest who could forgo imaging. In the US context PECARN focused on high baseline imaging rates with the goal of safely reducing the number of unnecessary imaging examinations.

The hallmarks of the PECARN prediction rules are the high methodological rigour, grounded in extensive preparatory pilot work to refine research processes and procedures; the use of large, prospectively collected multicentre data sets to achieve narrow confidence intervals (CIs); the high accuracy in identifying the conditions of interest; and the use of composite outcomes that are both clearly defined and clinically relevant for front-line clinicians. Another fundamental strength of the PECARN trauma rules is their evaluation in data sets that are representative of the intended target populations and a focus on validating the results not only as part of the initial derivation …