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The Pediatric Emergency Care Applied Research Network intermediate-risk predictors were not associated with scanning
Silvia Bressan1, Ivan P Steiner, Teresa Mion
1Department of Women's and Children's Health, University of Padova, Padova, Italy; Murdoch Children's Research Institute, Melbourne, Vic., Australia.
Insights
In children with minor head injuries, the Pediatric Emergency Care Applied Research Network (PECARN) intermediate-risk criteria did not predict computed tomography (CT) scan decisions. Infant age (<3 months) was the sole significant predictor for CT scans.
Area of Science:
- Pediatric emergency medicine
- Radiology
- Clinical decision-making
Background:
- Minor head injury (MHI) in children often necessitates careful evaluation to rule out serious conditions.
- The Pediatric Emergency Care Applied Research Network (PECARN) provides prediction rules to guide management, including computed tomography (CT) decisions.
- Identifying predictors for CT scans in intermediate-risk pediatric MHI patients is crucial for optimizing resource utilization and patient care.
Purpose of the Study:
- To determine the predictors associated with the decision to perform a computed tomography (CT) scan in children with a minor head injury (MHI).
- To evaluate the role of Pediatric Emergency Care Applied Research Network (PECARN) intermediate-risk criteria in guiding CT scan decisions for pediatric MHI.
- To identify key clinical factors influencing CT scan performance in this specific patient population.
Main Methods:
- A 1-year, cross-sectional study was conducted in an Italian pediatric emergency department.
- The study included children presenting within 24 hours of an MHI who met PECARN intermediate-risk criteria.
- Data on clinical variables and CT scan decisions were collected and analyzed.
Main Results:
- A total of 308 children were included, with 47% younger than 2 years.
- CT scans were performed in 13% of cases; 1.3% had a clinically important traumatic brain injury (ciTBI).
- Neither single nor multiple PECARN intermediate-risk predictors were associated with the decision to perform a CT scan. The strongest predictor was infant age (<3 months), with an odds ratio of 18.1.
Conclusions:
- The PECARN intermediate-risk predictors showed limited influence on the decision to perform a CT scan in children with MHI.
- Infant age, specifically being younger than 3 months, was the only significant clinical factor associated with the decision to obtain a CT scan.
- These findings suggest that clinical judgment, particularly regarding very young infants, plays a more substantial role than PECARN criteria in CT scan decisions for pediatric MHI.
Aim:
This study determined the predictors associated with the decision to perform a computed tomography (CT) scan in children with a minor head injury (MHI). We focused on those facing an intermediate risk of clinically important traumatic brain injury (ciTBI), according to the Pediatric Emergency Care Applied Research Network (PECARN) prediction rule.
Methods:
A 1-year, cross-sectional study was performed in an Italian paediatric emergency department, focusing on children presenting within 24 h of an MHI and meeting the PECARN intermediate-risk criteria.
Results:
We included 308 children, and 47% were younger than 2 years of age. CT scans were carried out on 13%, 1.3% had a ciTBI and one was initially missed but did not need neurosurgery following diagnosis. Single and multiple PECARN intermediate-risk predictors were not associated with whether a CT scan was carried out. The only clinical variable associated with the decision to perform a CT scan was if the child was <3 months of age (OR 18.1, 95% CI, 4.91-66.61).
Conclusion:
The PECARN intermediate-risk predictors did not play a major role in the decision to perform a CT scan. The only factor significantly associated with the decision to perform a CT scan was when the patient was younger than 3 months of age.
