Missed intracranial injuries are rare in emergency departments using the PECARN head injury decision rules

Bressan, Silvia; Berlese, Paola; Arpone, Marta; Steiner, Ivan P.; Titomanlio, Luigi; Dalt, Liviana Da

doi:10.1007/s00381-020-04660-0

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…Additionally, we followed up the patients via telephone 7~90 days after discharge from the PED, but 126 patients were lost to follow-up. However, one recent study [ 22 ] showed that missed intracranial injuries are rare when the PECARN rule is used. A total of 1.5% of the patients returned to the PED, only 0.19% underwent neuroimaging, and no patients needed neurosurgery or intensive care.…”

Section: Discussionmentioning

confidence: 99%

Validation of Pediatric Emergency Care Applied Research Network (PECARN) rule in children with minor head trauma

et al. 2022

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The Pediatric Emergency Care Applied Research Network (PECARN) rule is commonly used for predicting the need for computed tomography (CT) scans in children with mild head trauma. The objective of this study was to validate the PECARN rule in Korean children presenting to the pediatric emergency department (PED) with head trauma. This study was a multicenter, retrospective, observational cohort study in two teaching PEDs in Korea between August 2015 and August 2016. In this observational study, 448 patients who visited PEDs were included in the final analysis. Risk stratification was performed with clinical decision support software based on the PECARN rule, and decisions to perform CT scans were subsequently made. Patients were followed-up by phone call between 7 days and 90 days after discharge from the PED. The sensitivity and specificity were analyzed. The sensitivity was 100% for all age groups, and no cases of clinically important traumatic brain injury (ciTBI) were identified in the very-low-risk group. CT scans were performed for 14.7% of patients in this study and for 33.8% in the original PECARN study. The PECARN rule successfully identified low-risk patients, and no cases of ciTBI were missed despite the reduced proportion of patients undergoing CT scans.

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Section: Discussionmentioning

confidence: 99%

Validation of Pediatric Emergency Care Applied Research Network (PECARN) rule in children with minor head trauma

et al. 2022

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“…Participation in organized sport for children under 14 years of age is the leading cause of concussion (43%) [3] and has been associated with a six times greater risk of concussion as compared to other leisure physical activities [4]. Limited on-site medical coverage of school-sponsored sports [5] contributes to a majority (86%) of children seeking medical care from healthcare professionals in direct access settings (e.g., emergency department, outpatient clinics) [6,7] where follow up visits are uncommon (1-3%) [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

The Clinical Utility of the Child SCAT5 for Acute Concussion Assessment

et al. 2022

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Background The Child Sport Concussion Assessment Tool 5th Edition (Child SCAT5) was developed to evaluate children between 5 and 12 years of age for a suspected concussion. However, limited empirical evidence exists demonstrating the value of the Child SCAT5 for acute concussion assessment. Therefore, the purpose of our study was to examine differences and assess the diagnostic properties of Child SCAT5 scores among concussed and non-concussed middle school children on the same day as a suspected concussion. Methods Our participants included 34 concussed (21 boys, 13 girls; age = 12.8 ± 0.86 years) and 44 non-concussed (31 boys, 13 girls; age = 12.4 ± 0.76 years) middle school children who were administered the Child SCAT5 upon suspicion of a concussion. Child SCAT5 scores were calculated from the symptom evaluation (total symptoms, total severity), child version of the Standardized Assessment of Concussion (SAC-C), and modified Balance Error Scoring System (mBESS). The Child SCAT5 scores were compared between the concussed and non-concussed groups. Non-parametric effect sizes ($$r=\frac{Z}{\sqrt{n}}$$ r = Z n ) were calculated to assess the magnitude of difference for each comparison. The diagnostic properties (sensitivity, specificity, diagnostic accuracy, predictive values, likelihood ratios, and diagnostic odds ratio) of each Child SCAT5 score were also calculated. Results Concussed children endorsed more symptoms (p < 0.001, $$r$$ r =0.45), higher symptom severity (p < 0.001, $$r$$ r =0.44), and had higher double leg (p = 0.046, $$r$$ r =0.23), single leg (p = 0.035, $$r$$ r =0.24), and total scores (p = 0.022, $$r$$ r =0.26) for the mBESS than the non-concussed children. No significant differences were observed for the SAC-C scores (p’s ≥ 0.542). The quantity and severity of endorsed symptoms had the best diagnostic accuracy (AUC = 0.76–0.77), negative predictive values (NPV = 0.84–0.88), and negative likelihood ratios (-LR = 0.22–0.31) of the Child SCAT5 scores. Conclusions Clinicians should prioritize interpretation of the symptom evaluation form of the Child SCAT5 as it was the most effective component for differentiating between concussed and non-concussed middle school children on the same day as a suspected concussion.

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Clinical characteristics associated with pediatric traumatic intracranial hemorrhage

Tanaanantarak,

Suntornsawat,

Samphao

2024

Chinese Journal of Traumatology

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Missed intracranial injuries are rare in emergency departments using the PECARN head injury decision rules

Cited by 5 publications

References 29 publications

Validation of Pediatric Emergency Care Applied Research Network (PECARN) rule in children with minor head trauma

Validation of Pediatric Emergency Care Applied Research Network (PECARN) rule in children with minor head trauma

The Clinical Utility of the Child SCAT5 for Acute Concussion Assessment

Clinical characteristics associated with pediatric traumatic intracranial hemorrhage

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