Computed tomography of the head in children with mild traumatic brain injury

Am Surg. 2014 Sep;80(9):841-3.

Abstract

Pediatric Emergency Care Applied Research Network (PECARN) guidelines have a near 100 per cent negative predictive value for clinically important traumatic brain injury (ciTBI) in children with mild head injury (Glasgow Coma Score [GCS] 14 or 15). Our goal was to retrospectively apply their criteria to our database to determine the potential impact on the rates of unnecessary head computed tomography (CT) and ciTBI detection. The records of pediatric patients with GCS 14 to 15 that had a head CT for suspected TBI after blunt trauma from 2008 to 2010 were reviewed. Of 493 children, CT was negative in 447 (91%), but findings were present in 46 (9%). Applying PECARN recommendations, 178 (36%) met all six criteria but still underwent head CT; all were negative. The remaining 315 (64%) missed one or more PECARN criteria and underwent CT; only 46 (15%) had findings, and two (0.6%) required surgery. There were no false-negatives. The negative predictive value for ciTBI was 100 per cent. Observance of PECARN guidelines identifies children who do not require CT, increasing the yield of finding a ciTBI among those who cannot satisfy all six criteria.

MeSH terms

  • Adolescent
  • Brain Injuries / classification*
  • Brain Injuries / diagnostic imaging*
  • Child
  • Child, Preschool
  • Cost Control
  • Emergency Medical Services / standards*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Length of Stay
  • Male
  • Practice Guidelines as Topic*
  • Predictive Value of Tests
  • Severity of Illness Index
  • Tomography, X-Ray Computed / economics
  • Unnecessary Procedures / economics
  • Wounds, Nonpenetrating / diagnostic imaging*