Abstract
The Pediatric Emergency Care Applied Research Network (PECARN) rule is commonly used for predicting the need for computed tomography (CT) scans in children with mild head trauma. The objective of this study was to validate the PECARN rule in Korean children presenting to the pediatric emergency department (PED) with head trauma. This study was a multicenter, retrospective, observational cohort study in two teaching PEDs in Korea between August 2015 and August 2016. In this observational study, 448 patients who visited PEDs were included in the final analysis. Risk stratification was performed with clinical decision support software based on the PECARN rule, and decisions to perform CT scans were subsequently made. Patients were followed-up by phone call between 7 days and 90 days after discharge from the PED. The sensitivity and specificity were analyzed. The sensitivity was 100% for all age groups, and no cases of clinically important traumatic brain injury (ciTBI) were identified in the very-low-risk group. CT scans were performed for 14.7% of patients in this study and for 33.8% in the original PECARN study. The PECARN rule successfully identified low-risk patients, and no cases of ciTBI were missed despite the reduced proportion of patients undergoing CT scans.
Highlights
In the USA, more than 600,000 children visit the emergency department annually with head trauma, which is a leading cause of death [1]
computed tomography (CT) is the modality of choice for diagnosing traumatic brain injury, but ionizing radiation from CT scans can lead to malignancies, and the risk is higher in children [5,6,7]
The two hospitals adopted the Pediatric Emergency Care Applied Research Network (PECARN) rule in August 2015 as a part of a quality assurance campaign between August 2015 and August 2016, which focused on reducing CT scans, especially in pediatric patients, and on minimizing the rate of missed cases of clinically important traumatic brain injury
Summary
In the USA, more than 600,000 children visit the emergency department annually with head trauma, which is a leading cause of death [1]. The incidence of head trauma varies by country, with a range between 47 and 280 per 100,000 children [2]. CT is the modality of choice for diagnosing traumatic brain injury, but ionizing radiation from CT scans can lead to malignancies, and the risk is higher in children [5,6,7].
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