Predictability and stability testing to assess clinical decision instrument performance for children after blunt torso trauma

Abstract

Objective The Pediatric Emergency Care Applied Research Network (PECARN) has developed a clinical-decision instrument (CDI) to identify children at very low risk of intra-abdominal injury. However, the CDI has not been externally validated. We sought to vet the PECARN CDI with the Predictability Computability Stability (PCS) data science framework, potentially increasing its chance of a successful external validation. Materials & methods We performed a secondary analysis of two prospectively collected datasets: PECARN (12,044 children from 20 emergency departments) and an independent external validation dataset from the Pediatric Surgical Research Collaborative (PedSRC; 2,188 children from 14 emergency departments). We used PCS to reanalyze the original PECARN CDI along with new interpretable PCS CDIs developed using the PECARN dataset. External validation was then measured on the PedSRC dataset. Results Three predictor variables (abdominal wall trauma, Glasgow Coma Scale Score Conclusion The PCS data science framework vetted the PECARN CDI and its constituent predictor variables prior to external validation. We found that the 3 stable predictor variables represented all of the PECARN CDI’s predictive performance on independent external validation. The PCS framework offers a less resource-intensive method than prospective validation to vet CDIs before external validation. We also found that the PECARN CDI will generalize well to new populations and should be prospectively externally validated. The PCS framework offers a potential strategy to increase the chance of a successful (costly) prospective validation. Author summary Do predictability and stability testing inform how a clinical decision instrument for identifying children at low risk of intra-abdominal injuries undergoing intervention after blunt torso trauma will perform prior to external validation? The PECARN instrument has high prediction performance and stable predictor variables. The Predictability, Computability, Stability (PCS) framework identified high performing instruments after development but before external validation. The PECARN instrument has high predictability and stability for children after blunt torso trauma and should therefore undergo prospective external validation. PCS is an effective method for evaluating clinical decision instruments after development but prior to external validation.