PECARN Intra-Abdominal Injury Rule
PECARN intra-abdominal injury rule (Holmes 2013): 7 history/exam findings after blunt torso trauma in children; absence of all 7 identifies very low risk for IAI needing acute intervention.
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Example
- Evidence of abdominal wall trauma or seat-belt sign
- Yes
- GCS <14
- No
- Abdominal tenderness on exam
- Yes
- Vomiting
- Yes
- Thoracic wall trauma
- No
- Complaint of abdominal pain
- No
- Decreased breath sounds
- No
Result: PECARN IAI: 3 of 7 risk findings present -> NOT very low risk per Holmes 2013; consider imaging.
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What the result means
- all 7 absent
- Very low risk of clinically important IAI per Holmes 2013 (NPV 99.9%).
- any present
- Not very low risk per Holmes 2013; consider imaging.
What you enter
- Evidence of abdominal wall trauma or seat-belt sign
- GCS <14
- Abdominal tenderness on exam
- Vomiting
- Thoracic wall trauma
- Complaint of abdominal pain
- Decreased breath sounds
How this is calculated
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. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.