Are Pediatric Emergency Care Applied Research Network Rules (PECARN) Sufficient for Computed Cranial Tomography Decision in Pediatric Patients with Mild Head Trauma?

Abstract

Objective: In this study we aimed to investigate the applicability of Pediatric Emergency Care Applied Research Network (PECARN) rules for decision to perform computed cranial tomography (CCT) in pediatric patients with minor head trauma (MHT). Methods: 317 pediatric patients who underwent CCT for mild head trauma were evaluated retrospectively. The patients were classified in two groups according to PECARN rules: below 2 years old, above 2 years old and then, these patient groups were classified into two subgroups according to the compatibility with PECARN rules. The patients requiring CCT according to PECARN rules were classified as PECARN compatible (PECARN +), the patients who underwent CCT without the need of CCT according to PECARN were classified as PECARN incompatible (PECARN -). Results: Approximately 20% patients in PECARN (+) group had abnormalities leading to prolonged hospitalization and only 3.8% patients of PECARN (-) group had abnormalities. However, none of PECARN (-) group patients required follow-up longer than 48 hours in the hospital. The most common symptoms necessitate CCT in PECARN (+) group were scalp swelling, scalp hematoma and vomiting. In PECARN (-) group the most common signs were cuts in the scalp and dermal abrasions. The incidence of fracture in CCT was significantly higher in PECARN (+) group. Conclusion: Because CCT poses serious radiation exposure, neurological examination and clinical follow-up should be preferred in the evaluation of children with MHT. In conclusion, PECARN rules were sufficient for CCT decision in pediatric patients with MHT. J Clin Exp Invest 2016; 7 (1): 35-40 Key words: Minor head trauma, pediatric trauma, computed cranial tomography