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Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An
Jacques du Plessis1, Sharadini K Gounden1, Carolyn Lewis2
1Department of Diagnostic Radiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Implementing the Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) can reduce unnecessary CT scans for children with minor head injuries. Very low-risk patients can safely avoid CT scans, preventing radiation exposure.
Area of Science:
- Pediatric Emergency Medicine
- Radiology
- Clinical Decision Support
Background:
- Traumatic brain injury (TBI) is a significant cause of pediatric morbidity and mortality, particularly in low- and middle-income countries.
- Non-contrast brain CT is standard for diagnosing intracranial injuries but involves ionizing radiation exposure.
- The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) helps identify low-risk pediatric patients who may not need a CT scan.
Purpose of the Study:
- To evaluate the impact of introducing the PECARN CDR on CT utilization rates for pediatric patients with minor blunt head injuries.
- To assess the safety and efficacy of the PECARN CDR in a South African academic hospital setting.
Main Methods:
- An audit of pediatric patients with minor blunt head injuries referred for CT imaging was conducted over one year.
- Patient data was compared against PECARN CDR recommendations to assess CT appropriateness.
- Statistical analysis was performed to determine the significance of findings.
Main Results:
- Out of 100 patients, 20 were classified as very low risk, with no CT findings of TBI or clinically important TBI (ciTBI).
- Intermediate and high-risk groups showed varying rates of TBI and ciTBI (23% and 47% with CT features of TBI, respectively; 8% and 37% with ciTBI, respectively).
- A statistically significant finding (p < 0.01) indicated no ciTBI in the very low-risk group.
Conclusions:
- CT brain imaging can be safely omitted in pediatric patients identified as very low risk by the PECARN CDR, avoiding unnecessary radiation exposure.
- Implementing the PECARN CDR can lead to a significant reduction in CT utilization rates for appropriate pediatric head injury cases.
Background:
Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) aids clinicians in their decision-making processes whilst deciding whether a patient at very low risk of a clinically important TBI (ciTBI) requires a CT scan.
Objectives:
To establish whether the introduction of the PECARN CDR would affect CT utilisation rates for paediatric patients presenting with minor blunt head injuries to an academic hospital in Gauteng, South Africa.
Method:
This was an audit of paediatric patients who presented with minor blunt head injuries and were referred for CT imaging at an academic hospital in Gauteng, compared with PECARN CDR recommendations, over a 1-year period.
Results:
A total of 100 patients were referred for CT imaging. Twenty patients were classified as very low risk, none of whom had any CT findings of a TBI or ciTBI (p < 0.01). A total of 61 patients were classified as intermediate risk and 19 as high risk. In all, 23% of the intermediate and 47% of the high-risk patients had CT features of a TBI, whilst 8% and 37% had a ciTBI, respectively.
Conclusion:
Computed tomography brain imaging may be omitted in patients classified as very low risk without missing a clinically important TBI. Implementing the PECARN CDR in appropriate patients would reduce CT utilisation rates.
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