ADHERENCE TO THE PECARN PEDIATRIC HEAD INJURY RULE IN TWO CANADIAN EMERGENCY SETTINGS. (18th May 2018)

• Record Type: Journal Article
• Authors: Gariepy, Martin; Gravel, Jocelyn; Turcotte, Stéphane; Légaré, France; Melnick, Edward; Hess, Erik; Witteman, Holly; Lelaidier-Hould, Lania; Truchon, Catherine; Sauvé, Louise; Plante, Patrick; Lesage, Nathalie; Archambault, Patrick
• Is Part Of: Paediatrics & Child Health. Volume 23(2018)Supplement 1
• Page Start: e9
• Page End: e10
• Publication Date: 2018-05-18
• Subjects: Pediatrics -- Periodicals; Children -- Health and hygiene -- Periodicals; 618.92
• DOI: 10.1093/pch/pxy054.024
• Languages: English
• ISSNs: 1205-7088

Abstract

Abstract: BACKGROUND: Head computerized tomography (CT) increases the risk of cancer in children and should be carefully prescribed to paediatric patients with head injury. The Pediatric Emergency Care Applied Network (PECARN) validated a rule to identify children at risk of a clinically important traumatic brain injury (TBI) needing a head CT. OBJECTIVES: The objective was to evaluate adherence to the PECARN rule as a function of CT overuse (defined as a prescribed CT when not recommended by the rule) and underuse rates (no CT performed when recommended) in two Canadian emergency departments (EDs). DESIGN/METHODS: We conducted a retrospective chart review of children under 17 years of age seen in 2016 in a paediatric Level I (site 1) and a general Level II (site 2) trauma center. We reviewed charts to determine the appropriateness of head CT use according to the PECARN rule in a random subset of children presenting with a head trauma. Mandatory inclusion criteria were (1) that the head trauma occurred in the 24 hours prior to arrival to the ED, (2) a GCS over 13 and (3) and at least one sign or symptom of minor TBI. Patients with a special condition that could have influenced the decision to order a head CT were automatically excluded. When a patient did not receive a head CT when recommended by the rule, we reviewed medical records to determine if the patient has returned to the ED after his discharge within the next 30 days. RESULTS: 1546 eligible patients younger than 17 years consulted during the study period. Of the 203 randomly selected cases per setting, 16 (7.9%) and 24 (12%) respectively from sites 1 and 2 had a head CT performed. For the younger group (< 2), both overuse and underuse rates were below 3%. For the older group, overuse rates were higher in site 2 (9.3% (95%CI:4.8–17%) vs. 1.2% (95%CI:0.2–6.5%) ( P =.03)) and there was no difference in underuse rates (22% (95%CI:6.3–55%) vs 39% (95%CI:18–65%) ( P =.65)). For children who did not receive a head CT when recommended, none returned to the ED for a related complication. CONCLUSION: Overall, even if there may be slightly more overuse of head CTs in the Level II trauma center, results showed an excellent agreement with the PECARN rule when CT was not recommended. However, results also showed a deviation when CT was recommended, where a higher portion of patients than expected did not receive a head CT. Reasons to explain this behaviour will need further exploration.