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Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective
F Lorton1,2, C Poullaouec3, E Legallais3
1Department of Pediatric Emergency, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France. fleur.lorton@chu-nantes.fr.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) rule accurately identifies children with minor head trauma who are at very low risk of traumatic brain injury. This external validation confirms its high sensitivity and negative predictive value, supporting its clinical use.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Decision Rules
Background:
- The Pediatric Emergency Care Applied Research Network (PECARN) rule is crucial for assessing traumatic brain injury (TBI) risk in children with minor head trauma.
- Prospective validation in independent populations is needed to confirm its efficacy.
- This study addresses the need for external validation of the PECARN rule in a French pediatric cohort.
Purpose of the Study:
- To prospectively evaluate the diagnostic performance of the PECARN clinical decision rule.
- To assess the rule's accuracy in identifying children at very low risk of clinically-important traumatic brain injuries.
- To validate the PECARN rule in a diverse French pediatric population across multiple clinical settings.
Main Methods:
- A multicenter, prospective, non-interventional cohort study was conducted in three French emergency departments.
- Included were 1499 children under 16 years old with minor head trauma and Glasgow Coma Scale scores of 14-15.
- Patients presented within 24 hours of trauma, and cranial CT scans were analyzed.
Main Results:
- The PECARN rule demonstrated 100% sensitivity and 100% negative predictive value for clinically-important traumatic brain injuries.
- Of 1499 children, only 9 (0.6%) had clinically-important TBIs, none classified as very low risk by the rule.
- Cranial CT scans were performed on 5.1% of patients, indicating efficient rule application.
Conclusions:
- The PECARN clinical decision rule exhibits strong predictive performance for minor head trauma in children.
- External validation in this French cohort confirms the rule's high sensitivity and negative predictive value.
- The PECARN rule can reliably identify children with minor head trauma who do not require immediate CT scans, supporting its clinical implementation.
Background:
To date, the Pediatric Emergency Care Applied Research Network (PECARN) rule for identifying children who are at very low risk of clinically-important traumatic brain injuries after minor head trauma has not been validated prospectively in an independent population. Our goal was to evaluate the diagnostic performance of the PECARN clinical decision rule in a French pediatric population in multiple clinical settings.
Methods:
We conducted a multicenter, prospective, non-interventional cohort study of patients with minor head trauma who presented to three emergency departments in France. We enrolled patients younger than 16 years of age seeking a consultation within 24 h of head trauma with Glasgow Coma Scale scores of 14-15.
Results:
During the study period, we included 1499 children of which 421 (28 %) were under 2 years of age, and 955 (64 %) were male. A cranial computed tomography (CT) scan was performed on 76 patients (5.1 %). Of the 1499 included patients, 9 children (0.6 %) had a clinically-important traumatic brain injury, and none were classified as very low risk by the PECARN rule. In our study, the sensitivity of this clinical decision rule was 100 % (95 % CI 66.4 to 100 %), the specificity was 69.9 % (95 % CI 67.5 to 72.2 %) and the negative predictive value was 100 % (95 % CI 99.7 to 100 %).
Discussion:
Our study confirmed the good predictive performances of the PECARN clinical decision rule for minor head trauma in children. The PECARN rule performed similarly to our study and to its internal validation study.
Conclusions:
We conducted an external validation study of the PECARN clinical decision rule for the detection of clinically-important traumatic brain injuries in children with minor head trauma, according to the methodological standards. The PECARN rule successfully identified all patients with clinically-important traumatic brain injuries, with a limited use of CT scans. Conducting a broad validation study with a large cohort is a prerequisite to provide sufficient statistical power before authorizing its implementation and generalization.
Trial Registration:
This study has been registered in ClinicalTrials.gov with identifier number: NCT02752711 on April 27, 2016.
