Related Experiment Video
Updated: May 5, 2026
Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
Pediatric head trauma algorithm for head CT decision-making in the emergency department
Gabriele Savioli1, Iride Francesca Ceresa2, Andrea Piccioni3
1Department of Emergency Medicine, IRCCS Polyclinic San Matteo, Pavia, Italia.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) algorithm reduces head CT scans in pediatric patients with mild TBI, improving emergency department efficiency without compromising care.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Clinical Decision Support
Background:
- Traumatic brain injury (TBI) is a frequent reason for pediatric emergency department (ED) visits.
- Effective decision-making for head computed tomography (CT) in pediatric mild TBI is crucial.
- The Pediatric Emergency Care Applied Research Network (PECARN) TBI algorithm offers a standardized approach.
Purpose of the Study:
- To assess the application of the PECARN TBI algorithm for head CT decisions in pediatric ED patients.
- To evaluate the protocol's impact on ED crowding, length of stay, and boarding times.
- To determine the algorithm's effectiveness in managing mild TBI in children.
Main Methods:
- Retrospective study of 1372 children (≤15 years) with mild TBI admitted to a level 2 trauma center ED.
- Data collection included demographics, symptoms, amnesia, outcomes, and neurosurgical interventions.
- Analysis focused on head CT utilization, intracranial injuries (ICI), and ED operational metrics.
Main Results:
- Only 4.3% of patients required neuroimaging; 7 children had intracranial hemorrhage, with 1 needing immediate neurosurgery.
- No re-admissions for bleeding were reported.
- Protocol adoption did not negatively impact ED crowding and reduced the length of ED stay.
Conclusions:
- The PECARN TBI algorithm successfully reduced the number of brain CT scans in pediatric mild TBI cases.
- Implementation of the algorithm resulted in good clinical outcomes.
- The protocol effectively managed pediatric TBI without increasing ED crowding.
Background:
Traumatic brain injury is a common cause of admission in Emergency Department (ED) for pediatric patients. The aim of this study was to evaluate the application of the Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) algorithm in ED for head CT decision-making in pediatric patients. The secondary objective was to evaluate the impact of adherence to this protocol on ED crowding, length of stay, and boarding time.
Methods:
We conducted a retrospective study including children aged ≤ 15 years who were admitted in a level 2 trauma center ED for mild TBI from 1 January 2016 to 31 December 2019. Collected data included amnesia, symptoms, demographics, outcomes, length of ED stay, the patient's outcomes, including intracranial injuries (ICI) and injuries requiring neurosurgery.
Results:
A total of 1372 children with mild TBI were included. More than half of the patients were male (59.8%) and ≥ 2 years of age (63.2%). Most of the trauma events (58%) were caused by home injury. Neurosurgical consultation (59.4%) was the most common intervention in the ED. Only 4.3% of patients required neuroimaging and 7 children had intracranial hemorrhage, with only 1 requiring immediate neurosurgical intervention. There were no re-admissions for bleeding. The adoption of this protocol had no negative impact on crowding, and a reduction of ED length of stay.
Conclusions:
The adoption of the PECARNE algorithm led to fewer brain computed tomography scans with good clinical outcomes without increasing crowding.
