Comparison of Emergency medicine physician's decision and Pecarn scale suggestions on pediatric head trauma patients

Abstract

INTRODUCTION: To determine head CT scan necessity in pediatric head trauma patients and to compare the decisions of Emergency medicine physicians (EMP) and PECARN scale suggestions on head CT scan necessity. METHODS: Our study was conducted retrospectively in our third stage hospital between January 2014 and December 2014. Patients under the age of 13 with head injury because of fall were included. Registry of all patients was analyzed and PECARN scale was applied to each patient's data retrospectively. Suggestions of PECARN scale were noted. Head CT scans were reported by radiologist. EMP's decision and PECARN scale suggestions were compared. Patients whom should had CT scan by PECARN scale suggestions but had no imaging were contacted and questioned about any other reasons to seek medical care. RESULTS: PECARN suggestion and EMP's decisions of CT necessity compared. Concordance analysis of two results are determined as 76.6% (Kappa coefficient: 0.766). EMP's decisions had 88.76% sensitivity, 91.09% specificity, 78.22% positive predictive value, 95.74% negative predictive value and 90.48% accuracy. DISCUSSION AND CONCLUSION: In assessment of children with minor head injury EMP decision and PECARN scale were found coherent and sufficient. Instead of early decision of CT scan, observation of patient can reduce radiation exposure, but cost effectivity of this approach should be evaluated by further studies.

Keywords

• pediatric head trauma
• pecarn
• emergency medicine physician