Application of PECARN rules would significantly decrease CT rates in a Dutch cohort of children with minor traumatic hea
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ORIGINAL ARTICLE
Application of PECARN rules would significantly decrease CT rates in a Dutch cohort of children with minor traumatic head injuries Nicky Niele 1,2 & Marlies van Houten 3 & Ellen Tromp 4 & J.B. van Goudoever 2 & Frans B. Plötz 1,2 Received: 31 January 2020 / Revised: 25 March 2020 / Accepted: 8 April 2020 # The Author(s) 2020
Abstract The aim of this study was to determine the potential impact of the Pediatric Emergency Care Applied Research Network (PECARN) rules on the CT rate in a large paediatric minor traumatic head injury (MTHI) cohort and compare this with current national Dutch guidelines. This was a planned sub-study of a prospective multicentre observational study that enrolled 1006 children younger than 18 years with MTHI. We calculated the number of recommended CT scans and described trauma-related CT scan abnormalities. The PECARN rules recommended a significantly lower percentage of CT scans in all age categories, namely 101/357 (28.3%) versus 164/357 (45.9%) (p < 0.001) in patients under 2 years of age and 148/623 (23.8%) versus 394/ 623 (63.2%) (p < 0,001) versus in patients 2 years and older. Conclusion: The projected CT rate can significantly be reduced if the PECARN rules are applied. We therefore advocate that the PECARN guidelines are also implemented in The Netherlands. What is Known: • To guide clinicians whether to perform a CT scan in children with a minor traumatic head injury (MTHI) clinical decision rules has been developed. • The overall CT scan rate in adherence with the Dutch MTHI guidelines is 44%. What is New: • The projected CT rate can significantly be reduced in a Dutch cohort of MTHI if the PECARN rules are applied. • The Dutch national guidelines for MTHI can safely be replaced by the PECARN rules.
Keywords Computed tomography scan . Guidelines . Paediatric minor traumatic head injuries . Pediatric Emergency Care Applied Research Network
Communicated by Piet Leroy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00431-020-03649-w) contains supplementary material, which is available to authorized users. * Frans B. Plötz [email protected] Nicky Niele [email protected] Marlies van Houten [email protected]
1
Department of Paediatrics, Tergooi Hospital, Rijksstraatweg1, 1261 AN Blaricum, The Netherlands
2
Department of Paediatrics, Amsterdam UMC, Emma Children’s Hospital,, University of Amsterdam, Amsterdam, The Netherlands
3
Department of Paediatrics, Spaarne Gasthuis, Hoofddorp, The Netherlands
4
Department of Epidemiology and Statistics, St Antonius Hospital, Nieuwegein, The Netherlands
Ellen Tromp [email protected] J.B. van Goudoever [email protected]
Eur J Pediatr
Abbreviations CATCH The Canadian Assessment of Tomography for Childhood Head Injury rule CHALICE The Children’s Head Injury Algorithm for the Prediction of Important Clinical Events ciTBI Clinically important traumatic brain injury CT Computed tomography GCS Glasgow Coma Score MTHI Minor traumatic head i
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