PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department

Alessandro Gambacorta; Marianna Moro; Antonietta Curatola; Federica Brancato; Marcello Covino; Antonio Chiaretti; Antonio Gatto

doi:10.1007/s00431-022-04424-9

PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department

Eur J Pediatr. 2022 May;181(5):2147-2154. doi: 10.1007/s00431-022-04424-9. Epub 2022 Feb 22.

Authors

Alessandro Gambacorta¹, Marianna Moro², Antonietta Curatola¹, Federica Brancato¹, Marcello Covino³, Antonio Chiaretti¹, Antonio Gatto⁴

Affiliations

¹ Dipartimento Di Pediatria, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
² Dipartimento Di Pediatria, Università Cattolica del Sacro Cuore, Rome, Italy.
³ Dipartimento Di Medicina d'Emergenza, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁴ Dipartimento Di Pediatria, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy. Antonio.gatto@policlinicogemelli.it.

Abstract

This study aims to evaluate the efficacy of the PECARN Rule (PR) in reducing radiological investigations in children with mild traumatic head injury in comparison with current clinical practice. A retrospective study was performed in our hospital between July 2015 and June 2020. Data of all children < 18 years of age admitted to the emergency department (ED), within 24 h after a head trauma with GCS ≥ 14, were analyzed. PECARN Rule was retrospectively applied to all patients. In total, 3832 patients were enrolled, 2613 patients ≥ 2 years and 1219 < 2 years. In the group of children ≥ 2 years, 10 presented clinically important traumatic brain injury (ciTBI) and were hospitalized, 7/10 underwent neurosurgery, and 3/10 clinical observation in the pediatric ward for more than 48 h. In children < 2 years, only 3 patients presented ciTBI, 2 underwent neurosurgery and 1 hospitalized. Applying the PR, no patient with ciTBI would have been discharged without an accurate diagnosis and we would have avoided 139 CT scans in patients ≥ 2 years, and 23 in those < 2 years of age (29% less).

Conclusion: We demonstrated the safety and validity of the PR in our setting with 100% sensitivity in both age groups in identifying patients with ciTBI and theoretically in reducing performed CT scans by 29%. Therefore, in patients classified in the low-risk category, it is a duty not to expose the child to ionizing radiation.

What is known: • CT is the gold standard to identify intracranial pathology in children with head injury but CT imaging of head-injured children expose them to higher carcinogenic risk. • PECARN Rules support doctors in identifying children with ciTBI in order to reduce exposure to ionizing radiation.

What is new: • We demonstrate the safety and validity of the PR with 100% sensitivity in both age groups in identifying patients with ciTBI. • In our setting, the application of PECARN Rule would theoretically have allowed us to reduce the CT scan by 29%.

Keywords: Emergency department; Head injury; PECARN Rule; Pediatric; Personalized medicine.

MeSH terms

Brain Injuries, Traumatic*
Child
Craniocerebral Trauma* / diagnostic imaging
Decision Support Techniques
Emergency Service, Hospital
Humans
Infant
Retrospective Studies