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A Novel Model of Mild Traumatic Brain Injury for Juvenile Rats
Published on: December 8, 2014
Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with
B Nakhjavan-Shahraki1, M Yousefifard2, M J Hajighanbari3
1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) rule effectively identifies clinically important TBI in children. This validated tool aids in screening high-risk pediatric patients with mild TBI.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Decision Rules
Background:
- The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prognostic rules are crucial for guiding computed tomography (CT) scan decisions in children with mild TBI.
- Validation of these rules in developing countries is essential for their global applicability.
Purpose of the Study:
- To evaluate the accuracy of the PECARN TBI prognostic rules in identifying children with clinically important TBI (ciTBI) in Iran.
- To assess the rule's performance in a developing country context.
Main Methods:
- A prospective cross-sectional study involving 594 children with mild TBI in Tehran, Iran.
- Application of the PECARN checklist, risk stratification (low, intermediate, high), and 2-week follow-up for ciTBI assessment.
- Evaluation of discrimination, calibration, and overall performance (Brier score) of the PECARN rule.
Main Results:
- The PECARN rule demonstrated high sensitivity (92.3% for <2 years, 100.0% for 2-18 years) in predicting ciTBI.
- Specificities were 40.6% (<2 years) and 57.8% (2-18 years).
- The rule showed proper calibration and good overall performance with Brier scores of 1.5 (<2 years) and 1.2 (2-18 years).
Conclusions:
- The PECARN prediction rule exhibits adequate validity for identifying ciTBI in children.
- The findings support the use of the PECARN rule for screening and identifying high-risk children with mild TBI in this setting.
Purpose:
Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prognostic rules is a scoring system for prediction of the need for computed tomography (CT) scanning in children with mild TBI. However, its validation has not been assessed in developing countries. Therefore, the present study was designed to assess the value of PECARN rule in identification of children with clinically important TBI (ciTBI).
Method:
In this prospective cross-sectional study, 594 children (mean age: 7.9 ± 5.3 years; 79.3% boys) with mild TBI brought to emergency ward of two healthcare centers in Tehran, Iran were assessed. PECARN checklist was filled for all patients and children were divided to three groups of low, intermediate and high risks. Patients were followed for 2 weeks by phone to assess their ciTBI status. At the end, discrimination power, calibration and overall performance of PECARN rule were assessed.
Results:
PECARN had a sensitivity and specificity of 92.3 and 40.6%, respectively, in predicting ciTBI in children under 2 years and 100.0 and 57.8%, respectively, in individuals between the ages of 2 and 18. PECARN rule had a proper calibration in prediction of ciTBI and CT scan findings. Brier score (overall performance) of PECARN rule in predicting ciTBI in children under 2 and 2-18 years were 1.5 and 1.2, respectively.
Conclusion:
PECARN prediction rule has a proper validity in the prediction of ciTBI. Therefor it can be used for screening and identification of high risk children with mild TBI.
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