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

Keywords

• Minor head trauma,pediatric trauma,computed cranial tomography

References

1. 1. Schutzman SA, Barnes P, Duhaime AC, et al. Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines. Pediatrics 2001;107:983- 993.
2. 2. Jan MMS, Camfield PR, Gordon K, et al. Vomiting after mild head injury is related to migraine. J Pediatr 1997;130:130-135.
3. 3. Andres BT: Management of delayed posttraumatic intracerebral hemorrhage. In: Contemporary Neurosurgery. Tindall GT. Wlliams and Wilkins. Baltimore 1988.
4. 4. Rosman NP. Acute Head Trauma. In McMillan JA, Feigin RD, DeAngelis C, Jones MD (Eds). Oski’s Pediatrics, Principles & Practices. Fourth Edition. Lippincott Williams & Wilkins, Philadelphia 2006;730-746.
5. 5. McLaurin RL, Towbin R. Diagnosis and treatment of head injury in infants and children. In: Youmans JR ed. Neurological Surgery. 3rd ed. Philadelphia: W.B. Saunders Co 1990;2149-2193.
6. 6. Brenner D, Elliston C, Hall E, Berdon W: Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001;176:289-296,
7. 7. Kuppermann N, Holmes JF, Dayan PS, et al. Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009;3;374:1160- 1170.
8. 8. Haydel MJ, Preston CA, Mills TJ, et al. Indications for computed tomography in patients with minor head injury. N Engl J Med 2000;343:100-105.

9. 9. Simşek O, Hiçdönmez T, Hamamcıoğlu MK, et al. Pediatric head injuries: a retrospective analysis of 280 patients. Ulus Travma Derg 2005;11:310-317.
10. 10. Verma S, Lal N, Lodha R, Murmu L. Childhood trauma profile at a tertiary care hospital in India. Indian Pediatr 2009;46:168-171.
11. 11. Wong AC, KowalenkoT, Roahen-Harrison S, et al. A Survey of emergency physicians’ fear of malpractice and its association with the decision to order computed tomography scans for children with minor head trauma. Pediatr Emerg Care 2011;27:182-185.
12. 12. Turedi S, Hasanbasoglu A, Gunduz A, Yandi M. Clinical decision instruments for CT scan in minor head trauma. J Emerg Med 2008;34:253-259.
13. 13. Mannix R, Meehan WP, Monuteaux MC, Bachur RG. Computed tomography for minor head injury: Variation and trends in major United States pediatric emergency departments. J Pediatr 2012;160:136-139.
14. 14. Servadei F, Teasdale G, Merry G. Neurotraumatology Committee of the World Federation of Neurosurgical Societies. Defining acute mild head injury in adults: a proposal based on prognostic factors, diagnosis and management. J Neurotrauma 2001;18:657-664.