Medical Minute: Review of a clinical decision rule for CT imaging in pediatric head injuries: PECARN

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July 8, 2014 by dailybolusoflr

By Marrissa Baker, MD
·         Aims to identify children presenting after head injury with GCS 14-15 who are at low risk for clinically important TBI for whom CT not necessary

·         Clinically important TBI defined as death from TBI, neurosurgical intervention, intubation > 24 hours duration, or hospital admission ≥ 2 nights

·         Prospective cohort study that enrolled 42,412 children within 24 hours of head injury with derivation and validation populations

·         In low risk group <2 years, sensitivity and NPV 100%. In low risk group ≥2 years, sensitivity 96.8% and NPV 99.95%

·         Schonfeld et al. performed external validation study demonstrating sensitivity 100% and NPV 100% for low risk groups



Ref: Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Jr., Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009; 374(9696): 1160-70. 




A. <2 years, B. ≥ 2 years

Severe mechanism of injury defined as MVC with patient ejection, death of another passenger, or rollover; pedestrian or bicyclist without helmet struck by motorized vehicle, fall > 3 feet (age 5 feet (age ≥2 years); head struck by a high-impact object

Signs of altered mental status include agitation, somnolence, repetitive questioning, or slow response to verbal communication.



Ref:

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD, Jr., Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009; 374(9696): 1160-70. 
Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network (PECARN) head injury clinical prediction rules are reliable in practice. Archives of disease in childhood. Published online on January 15, 2014.

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