# Validation of Decision Rules for CT Use in Children with Abdominal or Head Trauma

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA AT DAVIS · 2020 · $596,664

## Abstract

PROJECT SUMMARY/ABSTRACT
Intra-abdominal injury (IAI) and traumatic brain injury (TBI) are the two leading causes of death in children
older than 1 year. Some IAIs and TBIs are difficult to identify, and failure to identify these injuries results in
preventable morbidity and mortality. Abdominal and cranial computerized tomography (CT) scanning have
become the reference standard for diagnosing IAI and TBI, and CT use has significantly increased over the
last 30 years. CT scanning, however, has important risks, particularly the risk of radiation-induced malignancy.
The risk of radiation-induced malignancy in young children is approximately one in 400 abdominal CT scans
and one in 1,200 cranial CT scans. Currently, fewer than 10% of abdominal and cranial CT scans obtained in
injured children demonstrate IAI or TBI, thus, CT scanning is used inefficiently. This inefficiency is primarily
driven by physician concerns of missing injuries and the lack of rigorous evidence regarding indications for CT
use after trauma. We have previously derived clinical decision rules for the use of abdominal or cranial CT
scanning in injured children. These rules were derived in large, diverse, multicenter populations, and are robust
and precise; however, these rules have not yet been externally validated in a large, multicenter setting.
Appropriate validation of derived clinical decision rules is required before clinical implementation. Such
validation should be performed in a large, diverse, multicenter population. The objectives of the current study
are to validate these previously derived, highly accurate generalizable decision rules for abdominal and cranial
CT scanning in injured children. Once validated, these decision rules will then provide the evidence for
appropriate use of CT in injured children. We will additionally collect data on CT use in children who are very
low risk for IAI or TBI by the decision rules. This information will then be used to assist in rule implementation.
Implementation of these rules will allow for timely identification of children with IAI or TBI in need of
intervention, while avoiding CT scanning in children with minimal risk of such injuries. The study will be a
prospective, multicenter observational validation study of children with blunt abdominal or head trauma at one
of six emergency departments in the national CTSA Emergency Care Translational Research Collaborative
(ECTRC). The emergency departments of this consortium evaluate more than 300,000 children of diverse
racial and ethnic backgrounds every year. More than 7,500 children with blunt abdominal and 20,000 children
with blunt head trauma will be enrolled over 3 ½ years at the participating centers. The variables in the
previously derived decision rules will be collected prior to CT scanning such that validation of the decision rules
can be performed in an unbiased fashion. Successful validation of these rules will enable implementation of the
rules into clinical care an...

## Key facts

- **NIH application ID:** 9928436
- **Project number:** 5R01HD084674-05
- **Recipient organization:** UNIVERSITY OF CALIFORNIA AT DAVIS
- **Principal Investigator:** James F. Holmes
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $596,664
- **Award type:** 5
- **Project period:** 2016-07-15 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9928436

## Citation

> US National Institutes of Health, RePORTER application 9928436, Validation of Decision Rules for CT Use in Children with Abdominal or Head Trauma (5R01HD084674-05). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9928436. Licensed CC0.

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