Background: Head trauma accounts for more than half a million pediatric emergency department (ED) visits every year in the United States; of which, 50-80% are defined as minor head trauma. Less than 4–8% of brain CT scans performed in children with minor head trauma display any evidence of traumatic brain injury (TBI) and less than 0.5% require neurosurgical intervention. Computed tomography (CT) scans remain the diagnostic test of choice to evaluate children with suspected traumatic brain injury (TBI). Unfortunately, the use of CT imaging is associated with radiation-induced malignancy. Despite the prediction rules developed in 2009 by The Pediatric Emergency Care Applied Research Network (PECARN) regarding whether to obtain a head CT, clinical practice still varies widely.
Objective: To validate the PECARN score in children with minor head trauma in a university affiliated community hospital.
Design/Methods: Retrospective medical record review of all patients less than 21 years of age old who underwent brain CT due to head trauma in 2017. Patients who met the appropriate documentation of the PECARN criteria for minor head trauma (PECARN score of 14 or 15 were included in the study). Statistical analysis focused on those patients who had positive and negative findings on head CT.
Results: 227 patients were included in the study. 68.9% were male, 52.2% African American, and the mean age was 15.1±5.5 years. 50 study subjects were defined as high risk, 95 subjects as intermediate risk, and 74 subjects as low risk. 1 patient was excluded due to incomplete documentation (CT was negative for TBI). Of the 10 patients (4%) that had a TBI on CT, the mean age was 8.1±7.7 years. 90% were male, and 77.8% African American. PECARN was high risk in 60% and intermediate risk in 40%. After adjusting for confounding variables, the relationship between TBI and high PECARN score, controlled for age, was significant (aOR 9.58, 95% CI: 2.1-43.2).
Conclusion: These data support the use of the PECARN prediction rules, which may be utilized in the evaluation regarding the use of neuroimaging in children with mild head trauma. Future investigations will be needed to prospectively assess the changes in CT use that result from widespread application of the PECARN rules.
