Missing the PECARN rule is related to head CT overuse in Mexican children with mild head trauma

Abstract

Introduction: Computed tomography (CT) overuse in children with mild head trauma can be avoided by applying the Pediatric Emergency Care Applied Research Network (PECARN) rule. The aims of this study were (1) to apply the PECARN rule to predict traumatic brain injury on head CT in Mexican pediatric patients with mild head trauma and (2) to evaluate the extent of head CT overuse in cases that did not meet the criteria of the PECARN rule. Materials and methods: We conducted a cross-sectional study of children aged 0-10 years with mild head trauma (Glasgow Coma Scale 14-15 points) in which a head CT was ordered by referring clinicians in the emergency department. The PECARN rule was applied retrospectively. Results: A total of 145 children with mild head trauma were included: 64 (44.8%) girls and 80 (55.2%) boys. The mean ages were 3.7 ± 2.5 and 2.7 ± 2.2 years, respectively. The PECARN rule was not fulfilled in 29 (20.0%) of 145 children; therefore, a head CT should have been omitted. The PECARN rule had a sensitivity of 97.5% (95% confidence interval [CI] 92.6-100) and a negative predictive value of 96.5% (95% CI 60.7-100) for predicting clinically important traumatic brain injury on CT in pediatric patients with mild head trauma. Conclusion: This is the first study in Mexico which shows that there is head CT overuse in pediatric patients with mild head trauma. This finding may be due to emergency department clinicians overlooking the PECARN rule.