Mild Head Trauma in a Paediatric Hospital: Analysis of the PECARN Rule, Traumatic Lesions on Head CT, and Functional
Pedro Abreu1, Dalila Forte2, Miguel Correia2
1Neurosurgery Department, Centro Hospitalar Universitário do Algarve, Faro, Portugal, pabreu@ulsalg.min-saude.pt.
Insights
Mild head trauma in children often requires head CT scans. The Pediatric Emergency Care Applied Research Network (PECARN) rule aids in appropriate CT use and management, with specific signs indicating potential traumatic CT findings.
Area of Science:
- Pediatric Emergency Medicine
- Neurotrauma
- Radiology
Background:
- Mild head trauma is common in children, with varied clinical management approaches.
- Uncertainty persists regarding optimal patient management, outcomes, head trauma prevention, and CT scan appropriateness.
- Adherence to the Pediatric Emergency Care Applied Research Network (PECARN) rule for CT prescription remains a topic of discussion.
Purpose of the Study:
- To analyze mild head trauma cases in pediatric patients undergoing head CT.
- To identify associations between clinical signs, injury mechanisms, CT findings, and patient outcomes.
- To evaluate the utility of the PECARN rule in guiding CT utilization and management.
Main Methods:
- Retrospective observational study of 311 pediatric mild head trauma patients who had head CT.
- Characterization of presenting signs, symptoms, injury mechanisms, CT lesions, and outcomes.
- Statistical analysis of associations between clinical factors, PECARN risk groups, and CT findings.
Main Results:
- 18.8% of patients under 2 years had CT traumatic lesions versus 7.9% over 2 years; most were skull fractures.
- Parietal/temporal/occipital scalp hematoma, age <3 months, and >2 vomits were linked to traumatic CT lesions.
- Clinically significant lesions were rare (0.56%), primarily in the PECARN high-risk group; no functional sequelae observed.
Conclusions:
- The PECARN rule is valuable for guiding CT scans and managing pediatric mild head trauma.
- Specific findings like scalp hematoma, young age, and vomiting predict traumatic CT results.
- The frequency of preventable head trauma highlights the need for enhanced public health policies and safety measures.
Introduction:
Mild head trauma is frequent in Paediatrics and its management varies widely across clinicians. Questions regarding patients' management, outcomes, head trauma prevention, the adequacy of computerized tomography (CT) prescription and the adherence to the Pediatric Emergency Care Applied Research Network (PECARN) rule are still discussed.
Methods:
We performed a retrospective observational study of mild head trauma patients who underwent head CT, characterizing the presenting signs and symptoms, mechanisms of injury, head CT lesions, and outcomes. Statistical associations between signs and symptoms, CT lesions, PECARN risk groups and outcomes were explored.
Results:
Three hundred and eleven patients were included, with 18.8% of patients under 2 years having CT traumatic lesions, against 7.9% of patients over 2 years old. The majority were aligned skull fractures. Parietal/temporal/occipital scalp haematoma, being under 3 months of age, and the presence of more than 2 vomits on admission, were associated with head CT traumatic lesions (OR 6.39, OR 2.84, OR 2.84, respectively). Clinically important lesions were rare (0.56%) and associated to the PECARN high-risk group (p = 0.005). All patients had no functional sequelae. The most common causes of head trauma were bed falls and ground falls. Baby stroller/egg falls due to no retention system usage were not rare and most bicycle fall victims were not wearing a helmet.
Conclusion:
This study reinforces the usefulness of PECARN rule guiding CT scans prescription and patients´ management. Parietal/temporal/occipital scalp haematoma, being under 3 months of age and having more than two vomits are associated traumatic CT findings. Preventable head trauma frequency underlines the need for public policies reinforcement.
