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Application of PECARN rules would significantly decrease CT rates in a Dutch cohort of children with minor traumatic
Nicky Niele1,2, Marlies van Houten3, Ellen Tromp4
1Department of Paediatrics, Tergooi Hospital, Rijksstraatweg1, 1261 AN, Blaricum, The Netherlands.
Insights
Applying the Pediatric Emergency Care Applied Research Network (PECARN) rules significantly reduces CT scans for pediatric minor traumatic head injuries. These guidelines can safely replace current Dutch protocols, lowering radiation exposure in children.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Clinical Decision Rules
Background:
- Clinical decision rules guide CT scan use in pediatric minor traumatic head injury (MTHI).
- Current Dutch guidelines result in a 44% CT scan rate for MTHI.
- The Pediatric Emergency Care Applied Research Network (PECARN) has developed evidence-based guidelines.
Purpose of the Study:
- To assess the impact of PECARN rules on CT scan rates in Dutch children with MTHI.
- To compare PECARN rule recommendations with existing national Dutch guidelines.
- To evaluate the potential for reducing CT utilization in pediatric MTHI.
Main Methods:
- A sub-study of a prospective multicenter observational study involving 1006 children with MTHI.
- Calculation of recommended CT scans based on PECARN rules versus Dutch guidelines.
- Analysis of trauma-related CT scan abnormalities.
Main Results:
- PECARN rules recommended significantly fewer CT scans across all age groups.
- For children under 2 years, PECARN recommended 28.3% CT scans versus 45.9% (Dutch guidelines).
- For children 2 years and older, PECARN recommended 23.8% CT scans versus 63.2% (Dutch guidelines).
Conclusions:
- Implementing PECARN rules can substantially decrease the CT scan rate in pediatric MTHI.
- PECARN guidelines offer a safer alternative to current Dutch national guidelines.
- Adoption of PECARN rules in the Netherlands is advocated to reduce unnecessary CT scans.
Abstract:
The aim of this study was to determine the potential impact of the Pediatric Emergency Care Applied Research Network (PECARN) rules on the CT rate in a large paediatric minor traumatic head injury (MTHI) cohort and compare this with current national Dutch guidelines. This was a planned sub-study of a prospective multicentre observational study that enrolled 1006 children younger than 18 years with MTHI. We calculated the number of recommended CT scans and described trauma-related CT scan abnormalities. The PECARN rules recommended a significantly lower percentage of CT scans in all age categories, namely 101/357 (28.3%) versus 164/357 (45.9%) (p < 0.001) in patients under 2 years of age and 148/623 (23.8%) versus 394/623 (63.2%) (p < 0,001) versus in patients 2 years and older.Conclusion: The projected CT rate can significantly be reduced if the PECARN rules are applied. We therefore advocate that the PECARN guidelines are also implemented in The Netherlands. What is Known: • To guide clinicians whether to perform a CT scan in children with a minor traumatic head injury (MTHI) clinical decision rules has been developed. • The overall CT scan rate in adherence with the Dutch MTHI guidelines is 44%. What is New: • The projected CT rate can significantly be reduced in a Dutch cohort of MTHI if the PECARN rules are applied. • The Dutch national guidelines for MTHI can safely be replaced by the PECARN rules.
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