Improving Diagnostic Testing Decisions for Pediatric Minor Head Trauma in the Emergency Department: A Two‐Year Prospective Implementation Study

2021 ◽  
Vol 56 (S2) ◽  
pp. 52-53
Author(s):  
Doug Wolfe ◽  
Andrew Knighton ◽  
Angelene Hunt ◽  
Neer Shrestha ◽  
Allison Neeley ◽  
...  
Keyword(s):  
Emergency Department ◽  
Head Trauma ◽  
Diagnostic Testing ◽  
Implementation Study ◽  
Minor Head Trauma

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

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Rasha D. Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Minor Head Trauma ◽  
Scan Rate

Abstract 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.

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

2020 ◽  
Author(s):  
Rasha Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Minor Head Trauma ◽  
Scan Rate

Abstract 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.

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

2020 ◽  
Author(s):  
Rasha Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Minor Head Trauma ◽  
Scan Rate

Abstract 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.

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

2020 ◽  
Author(s):  
Rasha Sawaya ◽  
Cynthia Wakil ◽  
Adonis Wazir ◽  
Sami Shayya ◽  
Iskandar Berbari ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
High Risk ◽  
Head Trauma ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Pediatric Emergency ◽  
Low Risk ◽  
Research Network ◽  
Minor Head Trauma

Abstract 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% to 16.5% post-PECARN (p=0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% to 11.4% (p=0.02). There was no significant decrease in CT rates in patients ≥2 years. There was no increase in bounce-backs numbers, nor in admission rates or positive CT findings among bounce-backs. Conclusions PECARN rules implementation reduced CT rates, most significantly among patients <2 years at low risk for ciTBI. The implementation did not increase the number of missed ciTBI.

Minor Head Trauma in Children: An Intervention to Decrease Functional Morbidity

PEDIATRICS ◽  
1987 ◽  
Vol 80 (2) ◽  
pp. 159-164
Author(s):  
Rosemary Casey ◽  
Stephen Ludwig ◽  
Marie C. McCormick
Keyword(s):  
Emergency Department ◽  
Health Status ◽  
Behavior Problems ◽  
Physical Health ◽  
Head Trauma ◽  
Minor Head Trauma ◽  
Physical Health Status ◽  
Discharge Instructions ◽  
And Behavior ◽  
Functional Morbidity

Minor head trauma is common among children and evokes strong parental reaction. Parents often rush the child to an emergency department or consult their pediatrician by telephone despite the minor nature of the injury. In a previous report we showed that children with minor head trauma appear to have limitations in their usual daily activities and a high rate of school absenteeism. This study was a prospective, randomized trial of an intervention designed to reduce this functional morbidity after head trauma. Parents in the control group (n = 168) received routine discharge instructions. Parents in the intervention group (n = 153) received a discharge interview during which the nurse gave more explicit and behaviorally oriented instructions. The nurse also called intervention parents the next day to reassure them and to urge that the children return to their usual routine. One month after the injury a questionnaire was administered by telephone to assess physical health status, social or functional limitations, and behavior problems. The majority of parents (85%) were anxious, and this was not alleviated by previous experience with head trauma. Triage nurses incorrectly rated one third of the parents as not anxious. Physical health status, role activity indices, and behavior problems, were similar for the intervention and control groups 1 month after the head injury. Subsequent morbidity was highly correlated with parental anxiety. In managing children with minor head trauma, pediatricians and emergency department physicians must focus their discharge instructions on the parent's anxiety, emphasize the minor severity of the injury, and urge that the children return to their usual routine.

scholarly journals 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

2020 ◽  
pp. 102490792097537
Author(s):  
Jon Soo Kim ◽  
Jin Cheol Kim ◽  
Won Young Sung
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Head Trauma ◽  
Emergency Care ◽  
Applied Research ◽  
Pediatric Emergency ◽  
Research Network ◽  
Minor Head Trauma ◽  
Pediatric Emergency Care

Background: Minor head trauma is frequently presented to the pediatric emergency department. Despite the burden this injury poses on public health, evidence-based clinical guidelines on the assessment and management of pediatric minor head trauma remain unestablished, particularly in children below 2 years. We aimed to assess the diagnostic accuracy of a clinical decision rule (Pediatric Emergency Care Applied Research Network rule) and physician discretion in the recognition of practically important traumatic brain injury in children below 2 years of age presenting with minor head trauma to the emergency department. Methods: The medical records of children younger than 2 years presenting with head trauma to the emergency department were reviewed with Glasgow Coma Scale scores of 14–15. Practically important traumatic brain injury is a clinically essential traumatic brain injury including all cranial abnormalities (e.g. skull fracture) detected by computed tomography. All predictor variables of the Pediatric Emergency Care Applied Research Network rule and practically important traumatic brain injury outcomes were validated. Results: We enrolled and analyzed 433 children below 2 years. The most frequently observed mechanisms of injury in decreasing order were as follows: falls > 90 cm, head struck by high-impact objects, slip down, and automobile traffic accident. Of 224 children, positive findings were observed in 35 and 144 had one or more predictors of Pediatric Emergency Care Applied Research Network rule. The sensitivity, specificity, and negative likelihood ratio of the Pediatric Emergency Care Applied Research Network rule for practically important traumatic brain injury were 94.3%, 41.3%, and 0.14, respectively. Conclusion: The Pediatric Emergency Care Applied Research Network rule would assist in clinical decision-making to appropriately detect potential head injuries in children below 2 years, thereby reducing unnecessary performance of computed tomography scan.

scholarly journals PECARN rule in diagnostic process of pediatric patients with minor head trauma in emergency department

2021 ◽  
Author(s):  
Alessandro Gambacorta ◽  
Marianna Moro ◽  
Antonietta Curatola ◽  
Federica Brancato ◽  
Marcello Covino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Ionizing Radiation ◽  
Head Trauma ◽  
Pediatric Patients ◽  
Age Groups ◽  
Diagnostic Process ◽  
Risk Category ◽  
Age Group ◽  
Minor Head Trauma

Abstract Aim: To evaluate the efficacy of the PECARN Rule (PR) in preventing the presence of clinically important traumatic brain (ciTBI).Methods: A retrospective study was performed to our hospital between July 2015 and June 2020. Data of all children <18 years of age admitted to the Emergency Department (ED), within the 24 hours after a head trauma with GCS ≥14, were analysed. PR was retrospectively applied to all patientsResults: 3832 patients were enrolled, 2613 patients ≥2 years and 1219 were younger. In the group of children ≥2 years, 10 presented ciTBI of which 7 underwent neurosurgery and 3 hospitalized. Applying the PR, no patient with ciTBI would have been discharged without a diagnosis. Between children <2 years, only 3 patients presented ciTBI, 2 underwent neurosurgery and 1 hospitalized. According the PR also in this age group no ciTBI would have been discharged without diagnosis. Conclusions: We demonstrate the total effectiveness of the PR in our setting. We found 100% sensitivity in both age groups in identifying patients with ciTBI. Therefore, in patients classified in the low-risk category, it is a duty of the physician not to expose the child to ionizing radiation.

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