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Cost-effectiveness of the PECARN rules in children with minor head trauma
Daniel K Nishijima1, Zhuo Yang2, Michael Urbich3
1Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury rules improve CT scan efficiency and reduce costs for children with head trauma. This strategy offers better outcomes and is more cost-effective than usual care.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Health Economics
Background:
- Computed tomography (CT) use in children with minor head trauma is often inefficient and inappropriate.
- Clinical prediction rules are needed to guide selective CT utilization.
- The Pediatric Emergency Care Applied Research Network (PECARN) developed traumatic brain injury (TBI) prediction rules.
Purpose of the Study:
- To conduct a cost-effectiveness analysis comparing the PECARN TBI prediction rules to usual care for selective CT use in children with minor head trauma.
- To evaluate the impact of PECARN rules on CT utilization, patient outcomes, and healthcare costs.
Main Methods:
- Decision analytic modeling was used to compare PECARN rules with usual care in a hypothetical cohort of 1,000 children.
- Outcomes evaluated included missed clinically important TBI, radiation-induced cancers, CT scans, and quality-adjusted life-year (QALY) losses.
- Costs included diagnostic testing, treatment, and hospital stay, derived from single-center data.
Main Results:
- The PECARN strategy was projected to miss slightly more TBIs (0.26 vs. 0.02 per 1,000) but used fewer CT scans (274 vs. 353) compared to usual care.
- Fewer radiation-induced cancers (0.34 vs. 0.45) and lower total costs ($904,940 vs. $954,420) were associated with the PECARN strategy.
- The PECARN strategy resulted in lower net QALY loss (-4.64 vs. -5.79) and dominated usual care.
Conclusions:
- Applying PECARN TBI prediction rules in children with minor head trauma leads to beneficial outcomes.
- The PECARN strategy is more cost-effective than usual care for managing pediatric head trauma.
- These rules improve the efficiency and appropriateness of CT utilization in pediatric emergency settings.
Study Objective:
To improve the efficiency and appropriateness of computed tomography (CT) use in children with minor head trauma, clinical prediction rules were derived and validated by the Pediatric Emergency Care Applied Research Network (PECARN). The objective of this study was to conduct a cost-effectiveness analysis comparing the PECARN traumatic brain injury prediction rules to usual care for selective CT use.
Methods:
We used decision analytic modeling to project the outcomes, costs, and cost-effectiveness of applying the PECARN rules compared with usual care in a hypothetical cohort of 1,000 children with minor blunt head trauma. Clinical management was directed by level of risk as specified by the presence or absence of variables in the PECARN traumatic brain injury prediction rules. Immediate costs of care (diagnostic testing, treatment [not including clinician time], and hospital stay) were derived on single-center data. Quality-adjusted life-year losses related to the sequelae of clinically important traumatic brain injuries and to radiation-induced cancers, number of CT scans, number of radiation-induced cancers, number of missed clinically important traumatic brain injury, and total costs were evaluated.
Results:
Compared with the usual care strategy, the PECARN strategy was projected to miss slightly more children with clinically important traumatic brain injuries (0.26 versus 0.02 per 1,000 children) but used fewer cranial CT scans (274 versus 353), resulted in fewer radiation-induced cancers (0.34 versus 0.45), cost less ($904,940 versus $954,420), and had lower net quality-adjusted life-year loss (-4.64 versus -5.79). Because the PECARN strategy was more effective (less quality-adjusted life-year loss) and less costly, it dominated the usual care strategy. Results were robust under sensitivity analyses.
Conclusion:
Application of the PECARN traumatic brain injury prediction rules for children with minor head trauma would lead to beneficial outcomes and more cost-effective care.
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