Association Between Parental Preference and Head Computed Tomography in Children With Minor Blunt Head Trauma

Ishida, Yasushi; Manabe, Atsushi; Oizumi, Aya; Otani, Norio; Hirata, Michio; Urayama, Kevin Y.; Saida, Yukihisa; Kusakawa, Isao; Fukui, Tsuguya

doi:10.1001/jamapediatrics.2013.1448

“…Indeed, the clinical assessment of children less than two years of age is challenging as their neurologic examination is di cult to obtain and interpret; they may be asymptomatic despite having a ciTBI, are at risk for abusive head trauma, and are more prone to skull fractures than older children. Additionally, despite being informed of the clinical inappropriateness and radiation risks of CT imaging, parents often prefer to be reassured with negative results for younger children (37). As this study's results…”

Section: Discussionmentioning

confidence: 69%

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

Sawaya

¹

,

Wakil

²

,

Wazir

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods: Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results: We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p=0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p=0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions: PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged <2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

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“…Indeed, the clinical assessment of children less than two years of age is challenging as their neurologic examination is difficult to obtain and interpret; they may be asymptomatic despite having a ciTBI, are at risk for abusive head trauma, and are more prone to skull fractures than older children. Additionally, despite being informed of the clinical inappropriateness and radiation risks of CT imaging, parents often prefer to be reassured with negative results for younger children [37]. As this study's results show, PECARN rules reduced uncertainty and improved accuracy in medical decision-making and thus provide support for ED physicians to predict which children can be safely managed without CT scanning [38].…”

Section: Discussionmentioning

confidence: 80%

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study

Sawaya

¹

,

Wakil

²

,

Wazir

³

et al. 2020

View full text Add to dashboard Cite

Background Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to December 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into < 2 and ≥ 2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p = 0.18). Among patients < 2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p = 0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p = 0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p = 0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged < 2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

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“…Indeed, the clinical assessment of children less than two years of age is challenging as their neurologic examination is di cult to obtain and interpret; they may be asymptomatic despite having a ciTBI, are at risk for abusive head trauma, and are more prone to skull fractures than older children. Additionally, despite being informed of the clinical inappropriateness and radiation risks of CT imaging, parents often prefer to be reassured with negative results for younger children (37). As this study's results show, PECARN rules reduced uncertainty and improved accuracy in medical decision-making and thus provide support for ED physicians to predict which children can be safely managed without CT scanning (38).…”

Section: Discussionmentioning

confidence: 80%

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

Sawaya

¹

,

Wakil

²

,

Wazir

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background: Managing children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation’s impact on CT rates and clinical outcomes. Methods: Retrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into <2 and ≥2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups. Results: We included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p=0.18). Among patients <2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p=0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p=0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs. Conclusions: PECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged <2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

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Association Between Parental Preference and Head Computed Tomography in Children With Minor Blunt Head Trauma

Cited by 13 publications

References 5 publications

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: A retrospective cohort study

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