TY - JOUR
T1 - PECARN algorithms for minor head trauma
T2 - Risk stratification estimates from a prospective PREDICT cohort study
AU - Paediatric Research in Emergency Departments International Collaborative (PREDICT)
AU - Bressan, Silvia
AU - Eapen, Nitaa
AU - Phillips, Natalie
AU - Gilhotra, Yuri
AU - Kochar, Amit
AU - Dalton, Sarah
AU - Cheek, John A.
AU - Furyk, Jeremy
AU - Neutze, Jocelyn
AU - Williams, Amanda
AU - Hearps, Stephen
AU - Donath, Susan
AU - Oakley, Ed
AU - Singh, Sonia
AU - Dalziel, Stuart R.
AU - Borland, Meredith L.
AU - Babl, Franz E.
PY - 2021/10
Y1 - 2021/10
N2 - Background: The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in an external cohort of patients and that of ciTBI associated with different combinations of high- or intermediate-risk predictors. Methods: This study was a secondary analysis of a large multicenter prospective data set, including patients with Glasgow Coma Scale scores of 14 or 15 conducted in Australia and New Zealand. We calculated ciTBI rates with 95% confidence intervals (CIs) for each PECARN risk category and combinations of related predictor variables. Results: Of the 15,163 included children, 4,011 (25.5%) were aged <2 years. The frequency of ciTBI was 8.5% (95% CI = 6.0%–11.6%), 0.2% (95% CI = 0.0%–0.6%), and 0.0% (95% CI = 0.0%–0.2%) in the high-, intermediate-, and very-low-risk groups, respectively, for children <2 years and 5.7% (95% CI = 4.4%–7.2%), 0.7% (95% CI = 0.5%–1.0%), and 0.0% (95% CI = 0.0%–0.1%) in older children. The isolated high-risk predictor with the highest risk of ciTBI was “signs of palpable skull fracture” for younger children (11.4%, 95% CI = 5.3%–20.5%) and “signs of basilar skull fracture” in children ≥2 years (11.1%, 95% CI = 3.7%–24.1%). For older children in the intermediate-risk category, the presence of all four predictors had the highest risk of ciTBI (25.0%, 95% CI = 0.6%–80.6%) followed by the combination of “severe mechanism of injury” and “severe headache” (7.7%, 95% CI = 0.2%–36.0%). The very few children <2 years at intermediate risk with ciTBI precluded further analysis. Conclusions: The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study. The risk estimates of ciTBI within the high- and intermediate-risk predictors will help further refine clinical judgment and decision making on neuroimaging.
AB - Background: The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision rules informed the development of algorithms that risk stratify the management of children based on their risk of clinically important traumatic brain injury (ciTBI). We aimed to determine the rate of ciTBI for each PECARN algorithm risk group in an external cohort of patients and that of ciTBI associated with different combinations of high- or intermediate-risk predictors. Methods: This study was a secondary analysis of a large multicenter prospective data set, including patients with Glasgow Coma Scale scores of 14 or 15 conducted in Australia and New Zealand. We calculated ciTBI rates with 95% confidence intervals (CIs) for each PECARN risk category and combinations of related predictor variables. Results: Of the 15,163 included children, 4,011 (25.5%) were aged <2 years. The frequency of ciTBI was 8.5% (95% CI = 6.0%–11.6%), 0.2% (95% CI = 0.0%–0.6%), and 0.0% (95% CI = 0.0%–0.2%) in the high-, intermediate-, and very-low-risk groups, respectively, for children <2 years and 5.7% (95% CI = 4.4%–7.2%), 0.7% (95% CI = 0.5%–1.0%), and 0.0% (95% CI = 0.0%–0.1%) in older children. The isolated high-risk predictor with the highest risk of ciTBI was “signs of palpable skull fracture” for younger children (11.4%, 95% CI = 5.3%–20.5%) and “signs of basilar skull fracture” in children ≥2 years (11.1%, 95% CI = 3.7%–24.1%). For older children in the intermediate-risk category, the presence of all four predictors had the highest risk of ciTBI (25.0%, 95% CI = 0.6%–80.6%) followed by the combination of “severe mechanism of injury” and “severe headache” (7.7%, 95% CI = 0.2%–36.0%). The very few children <2 years at intermediate risk with ciTBI precluded further analysis. Conclusions: The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study. The risk estimates of ciTBI within the high- and intermediate-risk predictors will help further refine clinical judgment and decision making on neuroimaging.
KW - child
KW - clinical decision rule
KW - PECARN
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85109605713&partnerID=8YFLogxK
U2 - 10.1111/acem.14308
DO - 10.1111/acem.14308
M3 - Article
C2 - 34236116
AN - SCOPUS:85109605713
SN - 1069-6563
VL - 28
SP - 1124
EP - 1133
JO - Academic Emergency Medicine
JF - Academic Emergency Medicine
IS - 10
ER -