Compliance with PECARN head injury decision rules in children under two years old

BACKGROUND: One of the most common complaints about presentation at the Emergency Department (ED) in childhood is minor head trauma. In recent years, clinical decision rules (CDRs) have been published to assist in determining the need for performing computed tomography (CT) in these patients. The present study aims to investigate the compliance with Pediatric Emergency Care Applied Research Network (PECARN) rules in the decisions for CT examination in children aged below two years old with minor head trauma in our center.
METHODS: This retrospective, single-center study was conducted on a patient group aged below two years old, who presented at the ED within 24 hours of a trauma incident and were diagnosed as mild head trauma Glasgow Coma Scale score 14 and 15).
RESULTS: A total of 262 patients were included in this study. Of these patients, 214 (81.7%) received CT examination, and 48 (18.3%) patients did not receive any CT examination. None of these 48 patients showed clinically important traumatic brain injury (ci TBI). Among 214 patients who received CT examination, 89 (34%) patients met the PECARN rules criteria and 125 (47.7%) patients did not meet PECARN rules criteria. None of the patients who received CT examination and did not meet the PECARN rules criteria showed ci TBI. Among 89 patients who recieved a CT examination and also met the PECARN rules criteria, only 4 (1.5%) patients showed ci TBI. According to these results, the rate of compliance with PECARN rules in our institution ED was 52.3%.
CONCLUSION: In this study, which was conducted by including all the predictor values of the PECARN guidelines, the rate of compliance with PECARN rules was determined to be very low. Using these rules directly or with modification could establish a starting point for clinicians to reduce the rates of unnecessary CT scans. However, the effects of the clinician’s experience, parental expectations, medicolegal constraints and economic factors on the decision making process should not be forgotten.

Ýki yaþýndan küçük çocuklarda PECARN kafa kravmasý klinik karar kurallarýna uyum

AMAÇ: Çocukluk çaðýnda acil servise baþvurularýn yaygýn nedenlerinden biri çoðunluðu minör olan kafa travmalarýdýr. Bu hastalarda BT (bilgisayarlý tomografi) çekim ihtiyacýnýn belirlenmesine yardýmcý olmasý amacýyla son birkaç yýlda bazý klinik karar kurallarý yayýnlanmýþtýr. Bu çalýþmada iki yaþýndan küçük minör kafa travmalý çocuklarda BT çekim kararlarýnda PECARN (Pediatric Emergency Care Applied Research Network) kurallarýna uyum araþtýrýldý.
GEREÇ VE YÖNTEM: Bu geriye dönük, tek merkezli çalýþma iki yaþýndan küçük, travma oluþumunu takip eden ilk 24 saat içinde acil servise ilk baþvurusunu yapan ve baþvuru Glaskow Koma Skala skorlarý 14 ve 15 olan hafif kafa travmalý hasta grubunda yürütüldü.
BULGULAR: Çalýþmaya toplam 262 hasta dahil edildi. Bu hastalarýn 214’üne (%81.7) BT incelemesi yapýldýðý, 48’ine (%18.3) yapýlmadýðý saptandý. BT taramasý yapýlmayan 48 hastanýn hiçbirinde klinik olarak önemli travmatik beyin hasarý geliþmediði belirlendi. BT incelemesi yapýlan 214 hastadan 89’unda (%34) BT çekim kararý verilirken PECARN kurallarýna uyulduðu, 125 (%47.7) hastada bu kurallarýna uyulmadýðý saptandý. PECARN kriterlerini karþýlamayan ve BT incelemesi yapýlan hastalarýn hiçbirinde klinik olarak önemli travmatik beyin hasarý geliþmediði, PECARN kriterlerini karþýlayan 89 hastanýn sadece dördünde (%1.5) klinik olarak önemli travmatik beyin hasarý geliþtiði saptandý. Bu sonuçlara göre, kurumumuzda PECARN kurallarýna uyum oraný %52.3 idi.
TARTIÞMA: PECARN kýlavuzunun tüm belirleyici kriterleri dahil edilerek yürütülen çalýþmamýzda PECARN kurallarýna uyum oranýnýn düþük olduðu saptanmýþtýr. Gereksiz BT çekim oranlarýnýn düþürülmesi için klinisyenlerin bu kurallarý direkt veya modifiye ederek kullanmasý iyi bir baþlangýç noktasý oluþturabilir. Fakat klinisyen deneyimi, ebeveyn beklentisi, medikolegal çekinceler ve ekonomik faktörlerin bu karar üzerindeki etkisi unutulmamalýdýr.