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Updated: Jul 27, 2026
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Use of Traumatic Brain Injury Prediction Rules With Clinical Decision Support
Peter S Dayan1, Dustin W Ballard2,3, Eric Tham4
1Division of Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York; psd6@columbia.edu.
Insights
Implementing clinical decision support with Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) rules modestly reduced computed tomography (CT) use in children with minor head trauma, though results varied by site.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Clinical Decision Support Systems
Background:
- Computed tomography (CT) is frequently overused in evaluating minor head trauma in children.
- The Pediatric Emergency Care Applied Research Network (PECARN) developed prediction rules to identify children at very low risk of clinically important traumatic brain injury (ciTBI).
- Computerized clinical decision support (CDS) can integrate these rules and risk information to guide CT utilization.
Purpose of the Study:
- To evaluate the impact of implementing PECARN TBI prediction rules and CDS on CT utilization for pediatric patients with minor head trauma.
- To assess whether providing risk stratification for ciTBI alongside CDS recommendations influences CT ordering patterns.
Main Methods:
- A nonrandomized trial with concurrent controls was conducted across 5 pediatric emergency departments (PEDs) and 8 general emergency departments (GEDs).
- Intervention sites utilized CDS providing CT recommendations and ciTBI risks based on PECARN criteria.
- The primary outcome was the rate of CT scans performed on patients under 18 years old with minor blunt head trauma, analyzed by site and controlling for time trends.
Main Results:
- CT rates decreased modestly (2.3%-3.7%) at 2 of 4 intervention PEDs for children at very low risk, with smaller, nonsignificant decreases at the other 2 PEDs.
- Intervention GEDs showed inconsistent CT rate decreases, with low baseline CT use in the very low-risk group.
- Overall, intervention sites demonstrated small decreases in CT rates (1.7%-6.2%) across all children with minor head trauma.
Conclusions:
- Implementation of TBI prediction rules and CDS resulted in modest, safe, but variable reductions in CT use for children with minor head trauma.
- The effectiveness of CDS varied across different emergency department settings (PEDs vs. GEDs).
- Observed secular trends also contributed to changes in CT utilization during the study period.
Objectives:
We determined whether implementing the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prediction rules and providing risks of clinically important TBIs (ciTBIs) with computerized clinical decision support (CDS) reduces computed tomography (CT) use for children with minor head trauma.
Methods:
Nonrandomized trial with concurrent controls at 5 pediatric emergency departments (PEDs) and 8 general EDs (GEDs) between November 2011 and June 2014. Patients were <18 years old with minor blunt head trauma. Intervention sites received CDS with CT recommendations and risks of ciTBI, both for patients at very low risk of ciTBI (no Pediatric Emergency Care Applied Research Network rule factors) and those not at very low risk. The primary outcome was the rate of CT, analyzed by site, controlling for time trend.
Results:
We analyzed 16 635 intervention and 2394 control patients. Adjusted for time trends, CT rates decreased significantly (P < .05) but modestly (2.3%-3.7%) at 2 of 4 intervention PEDs for children at very low risk. The other 2 PEDs had small (0.8%-1.5%) nonsignificant decreases. CT rates did not decrease consistently at the intervention GEDs, with low baseline CT rates (2.1%-4.0%) in those at very low risk. The control PED had little change in CT use in similar children (from 1.6% to 2.9%); the control GED showed a decrease in the CT rate (from 7.1% to 2.6%). For all children with minor head trauma, intervention sites had small decreases in CT rates (1.7%-6.2%).
Conclusions:
The implementation of TBI prediction rules and provision of risks of ciTBIs by using CDS was associated with modest, safe, but variable decreases in CT use. However, some secular trends were also noted.
