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PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department
Alessandro Gambacorta1, Marianna Moro2, Antonietta Curatola1
1Dipartimento Di Pediatria, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
The PECARN Rule (PR) safely identifies children with traumatic brain injury, reducing unnecessary CT scans by 29%. This guideline helps avoid radiation exposure in pediatric head injury cases.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Neurotrauma
Background:
- CT scans are crucial for diagnosing intracranial pathology in pediatric head injuries but pose a carcinogenic risk.
- The PECARN Rule aids clinicians in identifying children with clinically important traumatic brain injuries (ciTBI) to minimize radiation exposure.
Purpose of the Study:
- To evaluate the effectiveness of the PECARN Rule (PR) in reducing radiological investigations for children with mild traumatic head injuries.
- To compare the PR's efficacy against current clinical practices in pediatric head trauma management.
Main Methods:
- A retrospective study analyzed data from 3832 children under 18 with head trauma and GCS ≥ 14, admitted between July 2015 and June 2020.
- The PECARN Rule was retrospectively applied to all enrolled patients.
- Patients were stratified into two age groups: ≥ 2 years (2613) and < 2 years (1219).
Main Results:
- The study identified 10 ciTBI cases in children ≥ 2 years and 3 ciTBI cases in children < 2 years.
- Retrospective application of the PR indicated a potential 29% reduction in CT scans (139 in older children, 23 in younger children).
- No patient with ciTBI would have been discharged without appropriate diagnosis under the PR's guidance.
Conclusions:
- The PECARN Rule demonstrated 100% sensitivity in identifying ciTBI in both age groups within the study setting.
- The PR is safe and valid, theoretically reducing CT scans by 29% and preventing unnecessary radiation exposure in low-risk pediatric head injury patients.
Abstract:
This study aims to evaluate the efficacy of the PECARN Rule (PR) in reducing radiological investigations in children with mild traumatic head injury in comparison with current clinical practice. A retrospective study was performed in our hospital between July 2015 and June 2020. Data of all children < 18 years of age admitted to the emergency department (ED), within 24 h after a head trauma with GCS ≥ 14, were analyzed. PECARN Rule was retrospectively applied to all patients. In total, 3832 patients were enrolled, 2613 patients ≥ 2 years and 1219 < 2 years. In the group of children ≥ 2 years, 10 presented clinically important traumatic brain injury (ciTBI) and were hospitalized, 7/10 underwent neurosurgery, and 3/10 clinical observation in the pediatric ward for more than 48 h. In children < 2 years, only 3 patients presented ciTBI, 2 underwent neurosurgery and 1 hospitalized. Applying the PR, no patient with ciTBI would have been discharged without an accurate diagnosis and we would have avoided 139 CT scans in patients ≥ 2 years, and 23 in those < 2 years of age (29% less).
Conclusion:
We demonstrated the safety and validity of the PR in our setting with 100% sensitivity in both age groups in identifying patients with ciTBI and theoretically in reducing performed CT scans by 29%. Therefore, in patients classified in the low-risk category, it is a duty not to expose the child to ionizing radiation.
What Is Known:
• CT is the gold standard to identify intracranial pathology in children with head injury but CT imaging of head-injured children expose them to higher carcinogenic risk. • PECARN Rules support doctors in identifying children with ciTBI in order to reduce exposure to ionizing radiation.
What Is New:
• We demonstrate the safety and validity of the PR with 100% sensitivity in both age groups in identifying patients with ciTBI. • In our setting, the application of PECARN Rule would theoretically have allowed us to reduce the CT scan by 29%.
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