The Use of PECARN and CATCH Rules in Children With Minor Head Trauma Presenting to Emergency Department 24 Hours After Injury

Abstract

Objective: Major studies (PECARN [Pediatric Emergency Care AppliedResearch Network], CATCH [Canadian Assessment of Childhood Head Injury]) that regulate the use of computed tomography (CT) algorithms in children with minor head trauma (MHT) have been conducted among children presenting in 24 hours after injury. In this study, we aimed to compare use and results of PECARN and CATCH rules in children presenting in and after 24 hours following injury.Methods: Records of children who were admitted to emergency department and underwent CT imaging because of MHT during a 5-year period were retrospectively reviewed. Efficacy of PECARN and CATCH rules was investigated for predicting traumatic CT findings in patients presenting in and after 24 hours. Logistic regression was performed to evaluate whether presenting after 24 hours affected the ability of guidelines in predicting traumatic CT findings.Results: This study included 2490 patients who met the criteria. Of these patients, 6.7% (168/2490) presented after 24 hours following injury. Traumatic CT findings were found in 6.7% (168/2490) of patients. This rate was 6.9% (161/2322) in those presenting in 24 hours and 4.2% (7/168) in those presenting after 24 hours, and there was no significant difference in the incidence of traumatic CT findings between the 2 groups (P = 0.17). Among children presenting in 24 hours, the sensitivity of PECARN was 96.3% (95% confidence interval [CI], 91.7%-98.5%), whereas the sensitivity of CATCH was 91.9% (95% CI, 86.3%-95.4%) in detecting traumatic intracranial injury. The sensitivity of both PECARN and CATCH was 85.7% (95% CI, 42.0%-99.2%) among children presenting after 24 hours. Presence of CT scan indication according to PECARN statistically predicted intracranial damage, and this was not affected by the admission time.Conclusions: Patients with MHT presenting after 24 hours following injury constitute a clinically important population. Regardless of the admission time, current guidelines predict traumatic CT abnormalities.

Multicentre study found no increased risk of clinically important brain injuries when children presented more than 24 h after a minor head trauma

“…It has also been suggested that the scores that are currently available effectively predict the occurrence of significant injuries 18 . In contrast, data on paediatric patients have shown some conflicting results 12,13,15,19–21 . In our study, 4.1% of the cases presented to the emergency department 24 h after sustaining a minor head trauma, which was similar to other studies 13 …”

“…Risk group and imaging findings in children who presented early or late and underwent a neuroimaging study results. 12,13,15,[19][20][21] In our study, 4.1% of the cases presented to the emergency department 24 h after sustaining a minor head trauma, which was similar to other studies. 13 There was a slightly higher median age in the late access group, which reflected the tendency to take young infants to emergency departments earlier than older children, regardless of their symptoms.…”

“…Accurate and reliable decision‐making rules are available on using imaging in patients who present to emergency departments within 24 h of a head trauma 7–11 . However, there are a lack of clear‐cut indications on neuroimaging for children who access emergency departments after 24 h with a minor head trauma 12 . This leads to heterogeneous behaviour among clinicians and the extensive, and potentially inappropriate, use of CT 13 …”

“…[7][8][9][10][11] However, there are a lack of clear-cut indications on neuroimaging for children who access emergency departments after 24 h with a minor head trauma. 12 This leads to heterogeneous behaviour among clinicians and the extensive, and potentially inappropriate, use of CT. 13 The aim of this study was to compare the presence of clinically important traumatic brain injuries detecting by neuroimaging in children presenting to five Italian paediatric emergency departments within and after 24 h of sustaining a minor head trauma.…”

Identification of practically important traumatic brain injury using Pediatric Emergency Care Applied Research Network rule in children younger than 2 years with minor head trauma

“…Majority of past studies related to cranial CT decisionmaking aimed to identify ciTBI requiring acute intervention, particularly neurosurgery. 3,4,[10][11][12] CT scan is performed only when ciTBI is suspected to reduce the risk of exposure to radiation; however, ciTBI has an extremely low incidence in the range of 0.67% to 1.13%. 3,11 TBIs such as numerous skull fractures and ciTBI are observed in less than 10% of CT scans in children with minor head trauma.…”