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Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice
Deborah Schonfeld1, Silvia Bressan2, Liviana Da Dalt2
1Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA Division of Emergency Medicine, the Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) rules accurately identify children with minor head trauma who can safely avoid CT scans. This validation confirms their utility in clinical decision-making for pediatric head injuries.
Area of Science:
- Pediatric Emergency Medicine
- Neurology
- Radiology
Background:
- The Pediatric Emergency Care Applied Research Network (PECARN) developed age-based clinical prediction rules to identify children at low risk for traumatic brain injury (TBI).
- These rules aim to reduce unnecessary computed tomography (CT) scans in children with head injuries.
- Independent validation is crucial to confirm the generalizability and reliability of these prediction rules.
Purpose of the Study:
- To independently validate the PECARN age-based clinical prediction rules for traumatic brain injury (TBI) in children.
- To assess the accuracy of these rules in identifying children with a very low risk of significant head injury.
- To evaluate the potential of these rules in guiding CT scan decisions for pediatric blunt head trauma.
Main Methods:
- A cross-sectional study was conducted in two pediatric emergency departments in the USA and Italy.
- Included were children presenting with head injury and a Glasgow Coma Scale score of ≥ 14 within 24 hours.
- PECARN TBI clinical predictors were assessed, with clinically important TBI defined by specific adverse outcomes.
Main Results:
- 2439 children were included; 15% underwent CT, 3% had traumatic findings, and 0.8% had a clinically important TBI.
- The PECARN TBI prediction rules demonstrated 100% sensitivity and 100% negative predictive value for clinically important TBI.
- No children with clinically important TBI were classified as very low risk by the PECARN rules.
Conclusions:
- The age-based PECARN TBI prediction rules were accurately validated in an external cohort.
- These rules effectively identify children at very low risk for clinically significant TBI.
- The PECARN rules can assist in CT scan decision-making for children with minor blunt head trauma.
Objective:
The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) age-based clinical prediction rules identify children at very low risk of a significant head injury who can safely avoid CT. Our goal was to independently validate these prediction rules.
Design:
Cross-sectional study.
Setting:
Two paediatric emergency departments located in USA and in Italy.
Patients:
All children presenting within 24 h of a head injury with a Glasgow Coma Score of ≥ 14.
Intervention:
Assessment of PECARN TBI clinical predictors.
Main Outcome Measure:
Clinically important TBI defined as head injury resulting in death, intubation for >24 h, neurosurgery or two or more nights of hospitalisation for the management of head trauma.
Results:
During the study period, we included 2439 children (91% of eligible patients), of which 959 (39%) were < 2 years of age and 1439 (59%) were male. Of the study patients, 373 (15%) had a CT performed, 69 (3%) had traumatic findings on their CT and 19 (0.8%) had a clinically important TBI. None of the children with a clinically important TBI were classified as very low risk by the PECARN TBI prediction rules (overall sensitivity 100%; 95% CI 83.2% to 100%, specificity 55%, 95% CI 52.5% to 56.6%, and negative predictive value 100%, 95% CI 99.6% to 100%).
Conclusions:
In our external validation, the age-based PECARN TBI prediction rules accurately identified children at very low risk for a clinically significant TBI and can be used to assist CT decision making for children with minor blunt head trauma.