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Compliance with PECARN head injury decision rules in children under two years old
Aydın Gerilmez1, Arif Tarkan Calışaneller1
1Department of Neurosurgery, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, İstanbul-Turkey.
Insights
Compliance with Pediatric Emergency Care Applied Research Network (PECARN) rules for CT scans in children with minor head trauma was low at 52.3%. Adhering to PECARN guidelines could reduce unnecessary CT scans in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Clinical Decision Rules
Background:
- Minor head trauma is a frequent reason for pediatric emergency department visits.
- Clinical decision rules (CDRs) aid in determining the necessity of computed tomography (CT) scans for these patients.
- The Pediatric Emergency Care Applied Research Network (PECARN) provides specific guidelines for pediatric head trauma.
Purpose of the Study:
- To evaluate adherence to PECARN rules for CT scan decisions in children under two years old with minor head trauma.
- To assess the rate of compliance with PECARN guidelines in a single-center emergency department.
Main Methods:
- Retrospective, single-center study of patients under two years old presenting with minor head trauma within 24 hours of injury.
- Glasgow Coma Scale scores of 14-15 were used for diagnosis of mild head trauma.
- Analysis of CT scan utilization and correlation with PECARN rule criteria.
Main Results:
- 262 patients were included; 81.7% received CT scans.
- Only 34% of patients who received CT scans met PECARN criteria, while 47.7% did not.
- The overall compliance rate with PECARN rules was 52.3%, with no clinically important traumatic brain injuries (ci TBI) found in patients not meeting PECARN criteria.
- A low rate of ci TBI (1.5%) was observed in patients who met PECARN criteria and received a CT scan.
Conclusions:
- The study found a low compliance rate (52.3%) with PECARN rules in the management of minor head trauma in young children.
- Direct or modified application of PECARN rules may help reduce unnecessary CT scans.
- Factors such as clinician experience, parental expectations, medicolegal, and economic considerations can influence decision-making and should be considered.
Background:
One of the most common complaints about presentation at the Emergency Department (ED) in childhood is minor head trauma. In recent years, clinical decision rules (CDRs) have been published to assist in determining the need for performing computed tomography (CT) in these patients. The present study aims to investigate the compliance with Pediatric Emergency Care Applied Research Network (PECARN) rules in the decisions for CT examination in children aged below two years old with minor head trauma in our center.
Methods:
This retrospective, single-center study was conducted on a patient group aged below two years old, who presented at the ED within 24 hours of a trauma incident and were diagnosed as mild head trauma Glasgow Coma Scale score 14 and 15).
Results:
A total of 262 patients were included in this study. Of these patients, 214 (81.7%) received CT examination, and 48 (18.3%) patients did not receive any CT examination. None of these 48 patients showed clinically important traumatic brain injury (ci TBI). Among 214 patients who received CT examination, 89 (34%) patients met the PECARN rules criteria and 125 (47.7%) patients did not meet PECARN rules criteria. None of the patients who received CT examination and did not meet the PECARN rules criteria showed ci TBI. Among 89 patients who recieved a CT examination and also met the PECARN rules criteria, only 4 (1.5%) patients showed ci TBI. According to these results, the rate of compliance with PECARN rules in our institution ED was 52.3%.
Conclusion:
In this study, which was conducted by including all the predictor values of the PECARN guidelines, the rate of compliance with PECARN rules was determined to be very low. Using these rules directly or with modification could establish a starting point for clinicians to reduce the rates of unnecessary CT scans. However, the effects of the clinician's experience, parental expectations, medicolegal constraints and economic factors on the decision making process should not be forgotten.
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