Pediatric Thoracic Injury Rule out Criteria (pTIRC) in Diagnosis of Very Low Risk Children for Traumatic Intrathoracic Injuries; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: The value of thoracic injury rule out criteria (TIRC) as a tool for decreasing the number of unnecessary chest radiographs in children has not been evaluated yet. Therefore, the present study was designed as a multi-center study to assess the validity of TIRC model in detection of very low risk children for traumatic intrathoracic injuries.
Methods: In this diagnostic accuracy study, clinical data and chest radiographs of 974 children less than 18 years of age (72.0% boys) who had presented to 5 hospitals, in Iran in 2018 were assessed. Data gathering and interpretation of radiographs were done by two independent researchers in each hospital. In the end, discriminatory power and calibration of the model was assessed with a 95% confidence interval (95% Cl).
Results: In the present study, age was not a predicting factor of abnormal findings in radiographs of children and adolescents (p=0.75); therefore, it was omitted from TIRC model and pediatric TIRC (pTIRC) was designed. Area under the curve of pTIRC rule was 0.97 (95% CI: 0.96-0.98) for prediction of abnormal chest X-Ray in children and adolescents. The sensitivity and specificity of pTIRC was 100% and 90.1%, respectively. The calibration of this decision rule had great concordance with the perfect line with a slope of 0.99 and intercept of 0.001. There was a 90.1% reduction in the number of unnecessary chest radiographs when using pTIRC decision rule.
Conclusion: pTIRC decision rule was introduced in the present study. pTIRC has excellent performance in identification of traumatic intrathoracic injuries and decreasing the number of unnecessary chest radiographs.
- Clinical decision rules
- reproducibility of results
- multiple trauma
- sensitivity and specificity
How to Cite
Kortbeek JB, Al Turki SA, Ali J, Antoine JA, Bouillon B, Brasel K, et al. Advanced trauma life support, the evidence for change. Journal of Trauma and Acute Care Surgery. 2008;64(6):1638-50.
Hosseini M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, Ghanbari MJH, et al. Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis. Emergency. 2015;3(4):127.
Yousefifard M, Baikpour M, Ghelichkhani P, Asady H, Darafarin A, Esfahani MRA, et al. Comparison of Ultrasonography and Radiography in Detection of Thoracic Bone Fractures; a Systematic Review and Meta-Analysis. Emergency. 2016;4(2):55.
Rahimi-Movaghar V, Yousefifard M, Ghelichkhani P, Baikpour M, Tafakhori A, Asady H, et al. Application of Ultrasonography and Radiography in Detection of Hemothorax: a Systematic Review and Meta-Analysis. EMERGENCY-An Academic Emergency Medicine Journal. 2016;4(3):116-26.
Ebrahimi A, Yousefifard M, Kazemi HM, Rasouli HR, Asady H, Jafari AM, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos. 2014;13(4):29-40.
Forouzanfar MM, Safari S, Niazazari M, Baratloo A, Hashemi B, Hatamabadi HR, et al. Clinical decision rule to prevent unnecessary chest X-ray in patients with blunt multiple traumas. Emergency medicine Australasia : EMA. 2014;26(6):561-6.
Rodriguez RM, Anglin D, Langdorf MI, Baumann BM, Hendey GW, Bradley RN, et al. NEXUS chest: validation of a decision instrument for selective chest imaging in blunt trauma. JAMA surgery. 2013;148(10):940-6.
Hosseini M, Ataei N, Aghamohammadi A, Yousefifard M, Taslimi S, Ataei F. The relation of body mass index and blood pressure in Iranian children and adolescents aged 7-18 years old. Iranian journal of public health. 2010;39(4):126.
Hosseini M, Baikpour M, Yousefifard M, Yaseri M, Fayaz M, Shirafkan H, et al. Blood Pressure nomograms by Age and Weight for Iranian children and adolescents. International Journal of Pediatrics. 2016.
Hosseini M, Baikpour M, Yousefifard M, Fayaz M, Koohpayehzadeh J, Ghelichkhani P, et al. Blood pressure percentiles by age and body mass index for adults. EXCLI journal. 2015;14:465.
Gilbert CA, Lilley CM, Craig KD, McGrath PJ, Bennett SM, Montgomery CJ. Postoperative pain expression in preschool children: validation of the child facial coding system. The Clinical journal of pain. 1999;15(3):192-200.
Holmes JF, Palchak MJ, MacFarlane T, Kuppermann N. Performance of the pediatric Glasgow Coma Scale in children with blunt head trauma. Academic emergency medicine. 2005;12(9):814-9.
Balestreri M, Czosnyka M, Chatfield D, Steiner L, Schmidt E, Smielewski P, et al. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. Journal of Neurology, Neurosurgery & Psychiatry. 2004;75(1):161-2.
Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. Journal of biomedical informatics. 2014;48:193-204.
Wisbach GG, Sise MJ, Sack DI, Swanson SM, Sundquist SM, Paci GM, et al. What is the role of chest X-ray in the initial assessment of stable trauma patients? The Journal of trauma. 2007;62(1):74-8; discussion 8-9.
Safari S, Yousefifard M, Baikpour M, Rahimi-Movaghar V, Abiri S, Falaki M, et al. Validation of thoracic injury rule out criteria as a decision instrument for screening of chest radiography in blunt thoracic trauma. Journal of clinical orthopaedics and trauma. 2016;7(2):95-100.
Asgarzadeh S, Feizi B, Sarabandi F, Asgarzadeh M. Thoracic Injury Rule out Criteria in Prediction of Traumatic Intra-thoracic Injuries; a Validation Study. Emerg (Tehran). 2017;5(1) e27.
- Abstract Viewed: 150 times
- PDF Downloaded: 127 times
- HTML Downloaded: 44 times