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Pediatric minor head trauma in Brazil and external validation of PECARN rules with a cost-effectiveness analysis
Leopoldo Mandic Ferreira Furtado1,2, José Aloysio da Costa Val Filho1, André Ribeiro Dos Santos3
1Department of Pediatric Neurosurgery, Vila Da Serra Hospital , Nova Lima, Brazil.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) rules significantly reduce unnecessary head computed tomography (CT) scans in children with minor head trauma. Applying these guidelines in Brazil proved cost-effective, lowering overall healthcare expenses.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Health Economics
Background:
- Current approaches for pediatric minor head trauma focus on detecting brain lesions, minimizing radiation exposure, and controlling costs.
- The study addresses the need for rationalizing head computed tomography (CT) scan utilization in pediatric head trauma cases.
Purpose of the Study:
- To evaluate the applicability and cost-effectiveness of the Pediatric Emergency Care Applied Research Network (PECARN) rules for pediatric minor head trauma.
- To rationalize the use of head CT scans in this patient population.
Main Methods:
- A retrospective analysis of 1328 pediatric patients (<18 years) with minor head trauma treated at a single Brazilian institution.
- Patients were categorized into four groups based on imaging (X-ray, CT) or observation. Direct costs were calculated, and PECARN rules were retrospectively applied to reassess CT requirements and costs.
Main Results:
- CT scans were performed in 36.4% and X-rays in 52.6% of patients.
- Retrospective application of PECARN rules indicated that 77.6% of patients did not require a CT scan.
- Overall costs decreased significantly from USD 16.71 to 7.88 (p < .001) after applying the PECARN rules.
Conclusions:
- The PECARN rules demonstrated significant cost-effectiveness in managing pediatric minor head trauma.
- Implementation of PECARN rules is recommended for the Brazilian pediatric population to optimize resource utilization and reduce healthcare costs.
Background:
Pediatric minor head trauma approaches aim to ensure the absence of traumatic brain lesions, minimize ionizing radiation, and enhance cost control. We evaluated the applicability and cost-effectiveness of the Pediatric Emergency Care Applied Research Network (PECARN) rules after head trauma and rationalize the use of head computed tomography (CT) scans.
Methods:
We retrospectively divided patients <18 years old who presented at a single institution in Brazil with minor head trauma into four groups: Group I (skull X-ray only), Group II (head CT only), Group III (X-ray and CT), and Group IV (observation only). Direct costs were calculated based on examination and length of hospitalization. The PECARN rules were applied retrospectively in each patient to determine who required a CT scan, and the costs were re-calculated.
Results:
Of the 1328 patients, CT scans were performed in 36.4% and X-rays in 52.6%. The mean cost was USD 5.88, 34.58, 41.85, and 4.04 for Groups I-IV, respectively. After applying the PECARN rules, 77.6% of patients no longer required a CT scan, and overall costs were reduced from USD 16.71 to 7.88 (p < .001). Conclusion: The PECARN rules demonstrated a meaningful cost-effectiveness and should be applied to the Brazilian pediatric population.
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