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PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study.

Silvia Bressan1,2, Nitaa Eapen2,3, Natalie Phillips4,5

  • 1Department of Women's and Children's Health, University of Padova, Padova, Italy.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|July 8, 2021
PubMed
Summary

The Pediatric Emergency Care Applied Research Network (PECARN) head trauma rules accurately predicted clinically important traumatic brain injury (ciTBI) rates in an external cohort. These findings support refining clinical judgment for neuroimaging in children with head injuries.

Keywords:
PECARNchildclinical decision ruletraumatic brain injury

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Area of Science:

  • Pediatric Emergency Medicine
  • Trauma Surgery
  • Pediatric Neurology

Background:

  • The Pediatric Emergency Care Applied Research Network (PECARN) developed clinical decision rules for managing pediatric head trauma.
  • These rules stratify children by risk of clinically important traumatic brain injury (ciTBI).

Purpose of the Study:

  • To validate PECARN head trauma algorithm risk group ciTBI rates in an independent patient cohort.
  • To assess ciTBI risk associated with specific high- or intermediate-risk predictor combinations.

Main Methods:

  • Secondary analysis of a large, multicenter prospective dataset from Australia and New Zealand.
  • Included patients with Glasgow Coma Scale scores of 14 or 15.
  • Calculated ciTBI rates and 95% confidence intervals (CIs) for PECARN risk categories and predictor combinations.

Main Results:

  • ciTBI frequencies were 8.5% (high-risk) and 0.2% (intermediate-risk) in children <2 years; 5.7% and 0.7% in older children.
  • "Signs of palpable skull fracture" (11.4%) and "signs of basilar skull fracture" (11.1%) were high-risk predictors in younger and older children, respectively.
  • In older children, "all four predictors" (25.0%) and "severe mechanism/severe headache" (7.7%) indicated higher intermediate-risk ciTBI.

Conclusions:

  • PECARN algorithm risk estimates for ciTBI were consistent with the original study.
  • Risk estimates for high- and intermediate-risk predictors can refine clinical judgment and neuroimaging decisions in pediatric head trauma.