Accuracy of Pecarn Decision Rule in Minor Blunt Head Trauma in Pediatric Emergency Department: A Meta-Analysis

Abstract

Background: Pediatric Emergency Care Applied Research Network (PECARN) is a useful Clinical Decision Support Tool (CDST) to identify traumatic brain injuries and reduce the use of head CT scans among pediatric patients. The present Meta-analysis aims to evaluate the diagnostic accuracy of the PECARN rule from 2009 to 2020 in children with a very low risk of blunt head trauma. Methods: A detailed search was conducted from the databases of Medline (via PubMed), Cinahl (via Ebsco), Scopus, Web of Sciences, from 2009 till the end of December 2020 using the keywords like decrease use of CT scan, blunt head trauma (BHT) combined with accuracy, Pediatric Emergency Care Applied Research Network (PECARN) OR Clinical Decision Support Tool (CDST). Studies showing the diagnostic accuracy of the PECARN rule in children younger than 18 years of age with minor BHT were included. Results: 13 studies were included in the present analysis. Pooled sensitivity of 0.08, (95% confidence interval of 0.074 - 0.087), pooled specificity of 0.20 ( 95% CI of 0.196 - 0.213) and diagnostic odds ratio of 0.004 (95% CI of 0.000-0.1666) was in <2 years of age. The overall sensitivity of 0.07, specificity of 0.66, and diagnostic odds ratio of 0.54 (95% CI of 0.10 -2.78) was seen in ≥2 years of age. Overall sensitivity of 0.13 (95% CI 0.12-0.14), specificity of 0.81 (95% CI 0.80-0.82) and diagnostic odds ratio of 0.79 (95% CI of 0.08 -7.71) was in 0-18 years of age. Conclusion: The present analysis indicates the PECARN decision tool as an accurate CDST in low-risk minor blunt head trauma cases in children below two years of age and can become a useful tool in reducing Head CT’s scan overuse in pediatric emergency departments.