Availability of the Pediatric Emergency Care Applied Research Network (PECARN) rule for computed tomography scanning decision in children younger than 2 years with minor head injury

Abstract

Purpose Traumatic brain injury is the most common cause of pediatric injury. Although computed tomography (CT) scan is an effective modality for screening fatal craniocerebral trauma, there is growing concern about radiation exposure associated with the consequent cancer particularly in children. We assessed validity of previous large prospective study named Pediatric Emergency Care Applied Research Network (PECARN) retrospectively to determine the necessity of CT scans for children younger than 2 years with minor head injury. Methods We reviewed medical records of children younger than 2 years discharged from our emergency department with S00–09 diagnosis code of ICD-10 from August 2008 to December 2014. Patients who had only soft tissue injury without blunt trauma, did not CT scan take brain CT, whose head trauma was not mild, and who was uncertain to meet the rule were excluded. All included patients were divided into the PECARN rule positive group and negative group. Each group was compared by sensitivity, specificity, positive predictive value and negative predictive value to predict four outcomes of clinically important traumatic brain injury (ciTBI), abnormal CT findings, intracranial hemorrhage, and isolated simple skull fracture. Results A total of 1,491 patients were included, 656 PECARN rule positive and 835 negative patients. There is statistical difference between PECARN rule positive and negative the 2 group for ciTBI (P < 0.001), abnormal CT findings (P < 0.001), intracranial hemorrhage (P < 0.001), and isolated simple skull fracture (P < 0.001) with high sensitivity (100.0%, 89.5%, 91.7%,85.7%) and negative predictive value (100.0%, 99.3%, 99.6%, 99.6%). Conclusion We confirmed that PECARN rule is a useful tool to determine the necessity of CT scan and reduce unnecessary CT scan for children younger than 2 years with minor head injury.

Keywords

• craniocerebral trauma
• head
• pediatrics
• tomography
• radiation