EBQ:PECARN Pediatric Head CT Rule: Difference between revisions

Revision as of 18:41, 26 June 2014

Under Review Journal Club Article

Kuppermann N. et al. "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.". The Lancet. 2009. 374(9696):1160-1170.
PubMed Full text PDF

Clinical Question

Can children be identified for low risk clinically-important traumatic brain injury and avoid Brain CT imaging.

Conclusion

This validated clinical decision rule provides a means of decreasing brain CT imaging in children with blunt head trauma with a sensitivity of 100% (<2years old) and 96.8% (>2yrs old) for intracraneal injuries

Major Points

This rule was derived from the multicenter PECARN network with both an derivation and validation arm. Clinically important traumatic brain (cTBI) injury was defined as: death, intubation for > 24hrs, injury requiring neurosurgical intervetion, or a hospital admission ≥ 2 nights.

The rule stratifies patients < 2 years old and ≥2 years old.

<2 years old

Any 1 of the following?

GCS ≤14
Altered Mental Status
Palpable skull Fracture

Then obtain a Non-Con Brain CT (4.4% risk of cTBI)

1 or more of the following?

Non-frontal scalp hematoma
LOC ≥ 5 seconds
Severe injury mechanism
Abnormal activity per parents

Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)

≥2 years old

Any 1 of the following?

GCS ≤14
Altered Mental Status
Signs of a basilar skull fracture

Then obtain a Non-Con Brain CT (4.3% risk of cTBI)

1 or more of the following?

History of vomitting
LOC
Severe injury mechanism
Severe headache

Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)

Inclusion Criteria

Exclusion Criteria

Interventions

Outcome

Primary Outcomes

Secondary Outcomes

Subgroup analysis

Criticisms

Funding

Review Questions

Sources

Authors:

@@ Line 12: / Line 12: @@
 | pmid= 19758692
 | fulltexturl=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61558-0/fulltext
-| pdfurl=
+| pdfurl=http://www.pecarn.org/documents/kuppermann_2009_the-lancet.pdf
+| status = Under Review
 }}
 ==Clinical Question==
+Can children be identified for low risk  clinically-important traumatic brain injury and avoid Brain CT imaging.
 ==Conclusion==
+This validated clinical decision rule provides a means of decreasing brain CT imaging in children with blunt head trauma with a sensitivity of 100% (<2years old) and 96.8% (>2yrs old) for intracraneal injuries
 ==Major Points==
+This rule was derived from the multicenter [https://www.pecarn.org/ PECARN network]  with both an derivation and validation arm.  Clinically important traumatic brain (cTBI) injury was defined as: death, intubation for > 24hrs, injury requiring neurosurgical intervetion, or a hospital admission ≥ 2 nights.
+The rule stratifies patients < 2 years old and ≥2 years old.
+===<2 years old===
+;Any 1 of the following?
+#GCS ≤14
+#Altered Mental Status
+#Palpable skull Fracture
+''Then obtain a Non-Con Brain CT (4.4% risk of cTBI)''
+;1 or more of the following?
+#Non-frontal scalp hematoma
+#LOC ≥ 5 seconds
+#Severe injury mechanism
+#Abnormal activity per parents
+''Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)''
+===≥2 years old===
+;Any 1 of the following?
+#GCS ≤14
+#Altered Mental Status
+#Signs of a basilar skull fracture
+''Then obtain a Non-Con Brain CT (4.3% risk of cTBI)''
+;1 or more of the following?
+#History of vomitting
+#LOC
+#Severe injury mechanism
+#Severe headache
+''Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)''
 ==Inclusion Criteria==

	normal mental status
	no scalp hematoma except frontal
	no loss of consciousness or loss of consciousness < 5 seconds
	non-severe injury mechanism
	no palpable skull fracture