Results
The present meta-analysis included 13 studies out of 1051 studies based on the accuracy of PECARN, as shown in Figure 1. Among 13 articles, eight articles have categorized the patient sample as <2 years and ≥ 2 years of age, and five studies included patients as 0-18 years of age. A total sample size of 70,362 patients was included for the analysis from all the studies. Table 1 shows Demographic characteristics of included studies summarizing the author, time, place of study, study design, the severity of the injury, mean age, gender, practitioner assessing the patient, total sample size, and sample size depending on the age group.
For patients below two years of age, sensitivity analysis showed a pooled sensitivity of 0.08 (95% confidence interval [CI] of 0.074 - 0.087) with an inconsistency of 99.6%, which was significant at p<0.05 (Figure 2). Pooled specificity of 0.20 ( 95% CI of 0.196 - 0.213), which was significant at p <0.05 (Figure 3). The positive likelihood ratio was 0.17 (95% CI of 0.030 - 0.989), the negative likelihood ratio was 45.59 (95% CI 0.000 -0.166), and diagnostic odds ratio was 0.004 (95% CI of 0.000-0.1666) with a statistically significant value of p<0.05. ROC curve obtained showed the inclination of the curve towards the lower right depicting good diagnostic accuracy (Figure 4)
For patients equal to or above two years of age, sensitivity analysis showed a pooled sensitivity of 0.07 with an inconsistency of 99.5%, which was statistically significant (p<0.05) (Figure 5). Pooled specificity of 0.66 with the inconsistency of 99.9%, which was significant at p<0.05, was shown in Figure 6. The positive likelihood ratio was 1.46 (95% CI of 0.067 - 31.62), the negative likelihood ratio was 1.21 (95% CI 0.95 -1.54), and the diagnostic odd ratio was 0.54 (95% CI of 0.10 -2.78) with a statistically significant value of p<0.05. ROC curve obtained showed the inclination of the curve towards the lower left (Figure 7).
For the age group of 0-18years, sensitivity analysis showed a pooled sensitivity of 0.13 (95% CI 0.12-0.14) with an inconsistency of 86.7%, which was significant at p<0.05 (Figure 8). Pooled specificity of 0.81 (95% CI 0.80-0.82) with the inconsistency of 99.7%, significant at p<0.05, was shown in Figure 9. The positive likelihood ratio was 1.05 (95% CI of 0.25 – 4.34), the negative likelihood ratio was 1.36 (95% CI 1.05 -1.76), and the diagnostic odd ratio was 0.79 (95% CI of 0.08 -7.71) with a statistically significant value of p<0.05. ROC curve obtained showed the inclination of the curve towards the lower left (Figure 10).