Accuracy of Pediatric Emergency Care Applied Research Network Rules in Predicting Brain Injuries

Document Type : Original Article

Authors

1 Emergency and Trauma Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran

2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran

10.4103/atr.atr_5_22

Abstract

Background and Objectives: Head trauma is one of the most important causes of emergency department (ED) visits and the leading cause of disability and mortality in children. The aim of this study was to evaluate the Pediatric Emergency Care Applied Research Network (PECARN) rules to predict brain injuries in pediatrics with head trauma. Materials and Methods: This descriptive–analytic study was performed on 250 pediatric patients with head trauma referred to Imam Reza Hospital in Tabriz City from August to September 2020. All patients were evaluated in the ED for the existing of any rules of the PECARN, then the results of the PECARN rules and brain computed tomography (CT) scan findings were compared in these patients. According to the PECARN rules, patients were classified into three categories, namely low, moderate, and high risk. For all three groups, if there is an indication of brain CT scan, it was performed and reported by an emergency medicine specialist. Results: The mean age of the patients was 88 months. In this study, 162 (64.8%), 42 (16.8%), and 46 (18.4%) patients were in the low-risk, moderate-risk, and high-risk groups, respectively. Death was occurred in 18 (12.8%) patients. Results showed a statistically significant association between positive CT findings and some variables, such as behavioral change, vomiting, severe headache, LOC over 5 s, confusion, palpable skull fracture, skull base fracture, and the severe mechanism of injury (P < 0.05). Furthermore, a statistically significant association was found between PECARN rules and CT findings (P < 0.001). Conclusions: According to the results of the present study, PECARN rules have a significant association with brain CT scan findings. Therefore, using these rules is recommended to reduce the number of brain CT scan requests for pediatric patients.

Keywords

References

1.
Ide K, Uematsu S, Tetsuhara K, Yoshimura S, Kato T, Kobayashi T. External validation of the PECARN head trauma prediction rules in Japan. Acad Emerg Med 2017;24:308-14.  Back to cited text no. 1
    
2.
Lee S, Grant GA, Fisher PG, Imler D, Padrez R, Avery C, et al. R-SCAN: Imaging for pediatric minor head trauma. J Am Coll Radiol 2017;14:294-7.  Back to cited text no. 2
    
3.
Magana JN, Kuppermann N. The PECARN TBI rules do not apply to abusive head trauma. Acad Emerg Med 2017;24:382-4.  Back to cited text no. 3
    
4.
Marin JR, Weaver MD, Barnato AE, Yabes JG, Yealy DM, Roberts MS. Variation in emergency department head computed tomography use for pediatric head trauma. Acad Emerg Med 2014;21:987-95.  Back to cited text no. 4
    
5.
Rahmani F, Parsian Z, Ebrahimi Bakhtavar H, Salmasi S, Hashemi T. Epidemiologic feature and diagnostic outcome of traumatic pediatric patients referred to emergency department of Imam-Reza Hospital, Tabriz, Iran in 2016-2017. J Res Clin Med 2020;8:10.  Back to cited text no. 5
    
6.
Masoumi B, Heydari F, Hatamabadi H, Azizkhani R, Yoosefian Z, Zamani M. The relationship between risk factors of head trauma with CT scan findings in children with minor head trauma admitted to hospital. Open Access Maced J Med Sci 2017;5:319-23.  Back to cited text no. 6
    
7.
Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP, 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.  Back to cited text no. 7
    
8.
Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr., Atabaki SM, Holubkov R, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: A prospective cohort study. Lancet (London, England) 2009;374:1160-70.  Back to cited text no. 8
    
9.
Khajoei R, Abadi M, Dehesh T, Heydarpour N, Shokohian S, Rahmani F. Predictive value of the Glasgow coma scale, age, and arterial blood pressure and the new trauma score indicators to determine the hospital mortality of multiple trauma patients. Arch Trauma Res 2021;10:86-91.  Back to cited text no. 9
  [Full text]  
10.
Rahmani F, Ebrahimi Bakhtavar H, Shams Vahdati S, Hosseini M, Mehdizadeh Esfanjani R. Evaluation of MGAP and GAP Trauma Scores to Predict Prognosis of Multiple-trauma Patients. Trauma Monthly 2017;22:e33249.  Back to cited text no. 10
    
11.
Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, et al. Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. CMAJ 2018;190:E816-22.  Back to cited text no. 11
    
12.
Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: A prospective cohort study. Ann Emerg Med 2014;64:145-52, 52.e1-5.  Back to cited text no. 12
    
13.
Pickering A, Harnan S, Fitzgerald P, Pandor A, Goodacre S. Clinical decision rules for children with minor head injury: A systematic review. Arch Dis Child 2011;96:414-21.  Back to cited text no. 13
    
14.
Lorton F, Poullaouec C, Legallais E, Simon-Pimmel J, Chêne MA, Leroy H, et al. Validation of the PECARN clinical decision rule for children with minor head trauma: A French multicenter prospective study. Scand J Trauma Resusc Emerg Med 2016;24:98.  Back to cited text no. 14
    
15.
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;19:801-7.  Back to cited text no. 15
    
16.
Soleimanpour H, Mahmoodpoor A, Eftekhari Milani F, Shahsavari Nia K, Mehdizadeh Esfanjani R, Safari S. Effectiveness of oral ketamine, midazolam, and atropine cocktail versus oral diphenhydramine for pediatric sedation in the emergency department. Iran Red Crescent Med J 2014;16:e21366.  Back to cited text no. 16
    
17.
Luo P, Zhang L, Fei Z, Cheng G. Identification of children with low-risk brain injuries. Lancet 2010;375:198-9.  Back to cited text no. 17
    
Archives of Trauma Research
Volume 11, Issue 2
June 2022
Pages 86-89

Files

History

  • Receive Date: 18 June 2023
  • Accept Date: 18 June 2023

Share

How to cite

Statistics