Pediatric Emergency Care Applied Research Network head injuryprediction rules: on the basis of cost and effectiveness

Background/aim: Head injuries are commonly seen in the pediatric population. Noncontrast enhanced cranial CT is the method of choice to detect possible traumatic brain injury (TBI). Concerns about ionizing radiation exposure make the evaluation more challenging. The aim of this study was to evaluate the effectiveness of the Pediatric Emergency Care Applied Research Network (PECARN) rules in predicting clinically important TBI and to determine the amount of medical resource waste and unnecessary radiation exposure. Materials and methods: This retrospective study included 1041 pediatric patients presented to the emergency department. The patients were divided into subgroups of appropriate for cranial CT , not appropriate for cranial CT and cranial CT/observation of patient; both are appropriate . To determine the effectiveness of the PECARN rules, data were analyzed according to the presence of pathological findings Results: Appropriate for cranial CT results can predict pathology presence 118,056-fold compared to the not appropriate for cranial CT results. With cranial CT/observation of patient; both are appropriate results, pathology presence was predicted 11,457-fold compared to not appropriate for cranial CT results. Conclusion: PECARN rules can predict pathology presence successfully in pediatric TBI. Using PECARN can decrease resource waste and exposure to ionizing radiation.

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1. Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child 2014; 99: 427-431.
2. Dayan PS, Holmes JF, Atabaki S, Hoyle J Jr, Tunik MG, Lichenstein R. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med 2014; 63: 657-665.
3. Stanley RM, Hoyle JD Jr, Dayan PS, Atabaki S, Lee L, Lillis K, Gorelick MH, Holubkov R, Miskin M, Holmes JF et al. Emergency department practice variation in computed tomography use for children with minor blunt head trauma. J Pediatr 2014; 165: 1201-1206.e2.
4. Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA et al. Identification of children at very low risk of clinicallyimportant brain injuries after head trauma: a prospective cohort study. Lancet 2009; 374: 1160-1170.
5. Maguire JL, Boutis K, Uleryk EM, Laupacis A, Parkin PC. Should a head-injured child receive a head CT scan? A systematic review of clinical prediction rules. Pediatrics 2009; 124: e145-154.
6. Forsyth R, Pearce M. The price of failure: triage after apparently minor head injury. Arch Dis Child 2013; 98: 925-926.
7. Bressan S, Romanato S, Mion T, Zanconato S, Da Dalt L. Implementation of adapted PECARN decision rule for children with minor head injury in the pediatric emergency department. Acad Emerg Med 2012; 19: 801-807.
8. Levin DC, Rao VM, Parker L, Frangos AJ. Continued growth in emergency department imaging is bucking the overall trends. J Am Coll Radiol 2014; 11: 1044-1047.
9. Ringel JS, Eibner C, Girosi F, Cordova A, McGlynn EA. Modeling health care policy alternatives. Health Serv Res 2010; 45: 1541-1558.
10. Kamat AB, Midgley S, Kimbrell K. Duplication of radiology imaging studies in the emergency department: what is the cost? Emerg Med J 2015; 32: 144-148.
11. Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP. National trends in CT use in the emergency department: 1995-2007. Radiology 2011; 258: 164-173.
12. Smith-Bindman R, Miglioretti DL, Johnson E, Lee C, Feigelson HS, Flynn M, Greenlee RT, Kruger RL, Hornbrook MC, Roblin D et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA 2012; 307: 2400-2409.
13. Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med 2007; 357: 2277- 2284.
14. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, Howe NL, Ronckers CM, Rajaraman P, Craft AW et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; 380: 499-505.
15. Babl FE, Bressan S. Physician practice and PECARN rule outperform CATCH and CHALICE rules based on the detection of traumatic brain injury as defined by PECARN. Evid Based Med 2015; 20: 33-34.
16. Nishijima DK, Yang Z, Urbich M, Holmes JF, ZwienenbergLee M, Melnikow J, Kuppermann N. Cost-effectiveness of the PECARN rules in children with minor head trauma. Ann Emerg Med 2015; 65: 72-80.e6.
17. Arrey EN, Kerr ML, Fletcher S, Cox CS Jr, Sandberg DI. Linear nondisplaced skull fractures in children: who should be observed or admitted? J Neurosurg 2015; 16: 703-708.