EBQ:PECARN Pediatric Head CT Rule - Revision history

Danbot: Added Criticisms section

2026-03-21T22:40:01Z

Added Criticisms section

← Older revision		Revision as of 22:40, 21 March 2026
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	===Cost effectiveness===		===Cost effectiveness===
	The application of the [[PECARN Head Trauma]] CT rule has shown to lead to beneficial outcomes and more cost-effective care<ref>Nishijima DK. et al. Cost-effectiveness of the PECARN rules in children with minor head trauma. Ann Emerg Med. 2015 Jan;65(1):72-80</ref>		The application of the [[PECARN Head Trauma]] CT rule has shown to lead to beneficial outcomes and more cost-effective care<ref>Nishijima DK. et al. Cost-effectiveness of the PECARN rules in children with minor head trauma. Ann Emerg Med. 2015 Jan;65(1):72-80</ref>

			==Criticisms==
			*The "intermediate risk" group still requires clinical judgment regarding observation vs CT, which limits the rule's binary decision-making utility
			*The rule was derived and validated in academic pediatric EDs and may perform differently in community settings
			*"Severe mechanism" is subjectively defined and may lead to variable interpretation among clinicians
			*Isolated loss of consciousness without other findings has an extremely low risk of ciTBI, yet may still prompt imaging by many clinicians
			*The rule does not address the question of when to obtain repeat imaging in observed patients who clinically worsen

	==Funding==		==Funding==

Hkm91450: /* Conclusion */

2016-10-02T23:29:22Z

Conclusion

← Older revision		Revision as of 23:29, 2 October 2016
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	==Conclusion==		==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		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 intracranial injuries

	==Major Points==		==Major Points==

Ostermayer: Text replacement - "Category:Peds" to "Category:Pediatrics"

2016-03-22T15:59:50Z

Text replacement - "Category:Peds" to "Category:Pediatrics"

← Older revision		Revision as of 15:59, 22 March 2016
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	<references/>		<references/>

	[[Category:EBQ]][[Category:~~Peds~~]][[Category:Featured]]		[[Category:EBQ]][[Category:Pediatrics]][[Category:Featured]]

Ostermayer: /* Study Design */

2015-12-12T03:43:00Z

Study Design

← Older revision		Revision as of 03:43, 12 December 2015
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	{{Template:PECARN Head CT Rule}}		{{Template:PECARN Head CT Rule}}
	==Study Design==		==Study Design==
			Prospective cohort study in 25 emergency departments of the pediatric research network

	==Population==		==Population==
	*N=42,412		*N=42,412

Ostermayer: /* Review Questions */

2015-06-12T09:07:21Z

Review Questions

@@ Line 106: / Line 106: @@
 ==See Also==
 {{Head Trauma Links Template}}
 ==External Links==

Ostermayer: /* Further Discussion */

2015-06-12T09:07:12Z

Further Discussion

← Older revision		Revision as of 09:07, 12 June 2015
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	===Isolated Scalp Hematoma===		===Isolated Scalp Hematoma===
	*For '''isolated scalp hematoma''' a sub analysis post-hoc analysis of the 2,998 patients with isolated scalp hematomas none required a neurosurgical intervention. The risk of clinically important traumatic brain injury overall was less than 1 in 200. <ref>Dayan PS, et al. Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Ann Emerg Med. 2014 Aug;64(2):153-62. PMID: 24635991. Not all patients received a CT scan. 9% of the patients who received CT scan demonstrated traumatic brain injuries on CT. Risk factors were: younger age (especially <3 months), non-frontal scalp hematomas, increased scalp hematoma size, and more severe injury mechanism. A large hematoma was >3cm.</ref>		*For '''isolated scalp hematoma''' a sub analysis post-hoc analysis of the 2,998 patients with isolated scalp hematomas none required a neurosurgical intervention. The risk of clinically important traumatic brain injury overall was less than 1 in 200. <ref>Dayan PS, et al. Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Ann Emerg Med. 2014 Aug;64(2):153-62. PMID: 24635991. Not all patients received a CT scan. 9% of the patients who received CT scan demonstrated traumatic brain injuries on CT. Risk factors were: younger age (especially <3 months), non-frontal scalp hematomas, increased scalp hematoma size, and more severe injury mechanism. A large hematoma was >3cm.</ref>

			===Cost effectiveness===
			The application of the [[PECARN Head Trauma]] CT rule has shown to lead to beneficial outcomes and more cost-effective care<ref>Nishijima DK. et al. Cost-effectiveness of the PECARN rules in children with minor head trauma. Ann Emerg Med. 2015 Jan;65(1):72-80</ref>

	==Funding==		==Funding==

DrJeffRogers: /* Further Discussion */

2015-03-28T20:44:37Z

Further Discussion

← Older revision		Revision as of 20:44, 28 March 2015
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	*At Denver Health, this rule was demonstrated to be superior to the CHALICE and CATCH rules<ref>Easter J. et al. Comparison of PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury: A Prospective Cohort Study. Ann Emerg Med. 2014 Mar 10. PMID: 24635987</ref>		*At Denver Health, this rule was demonstrated to be superior to the CHALICE and CATCH rules<ref>Easter J. et al. Comparison of PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury: A Prospective Cohort Study. Ann Emerg Med. 2014 Mar 10. PMID: 24635987</ref>
	*The rarity of TBI in children was reinforced when analyzing those with isolated vomitting and no other positive factors on the decision rule<ref>Dayan, P. et al. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med. 2014 Jun;63(6):657-65. PMID: 24559605</ref>		*The rarity of TBI in children was reinforced when analyzing those with isolated vomitting and no other positive factors on the decision rule<ref>Dayan, P. et al. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med. 2014 Jun;63(6):657-65. PMID: 24559605</ref>
	*For '''isolated scalp hematoma''' a sub analysis post-hoc analysis of the 2,998 patients with isolated scalp hematomas required a neurosurgical intervention. The risk of clinically important traumatic brain injury overall was less than 1 in 200. <ref>Dayan PS, et al. Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Ann Emerg Med. 2014 Aug;64(2):153-62. PMID: 24635991.</ref>		===Isolated Scalp Hematoma===
			*For '''isolated scalp hematoma''' a sub analysis post-hoc analysis of the 2,998 patients with isolated scalp hematomas none required a neurosurgical intervention. The risk of clinically important traumatic brain injury overall was less than 1 in 200. <ref>Dayan PS, et al. Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Ann Emerg Med. 2014 Aug;64(2):153-62. PMID: 24635991. Not all patients received a CT scan. 9% of the patients who received CT scan demonstrated traumatic brain injuries on CT. Risk factors were: younger age (especially <3 months), non-frontal scalp hematomas, increased scalp hematoma size, and more severe injury mechanism. A large hematoma was >3cm.</ref>

	==Funding==		==Funding==

DrJeffRogers: /* Review Questions */

2015-03-28T20:41:25Z

Review Questions

← Older revision		Revision as of 20:41, 28 March 2015
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	==Review Questions==		==Review Questions==
	<quiz display=simple>		<quiz display=simple>
	{~~Journal club article:~~ Regarding pediatric head trauma patients, which of the following were predictors of “very low risk for clinically significant injury in children less than 2 years of age”?		{Regarding pediatric head trauma patients, which of the following were predictors of “very low risk for clinically significant injury in children less than 2 years of age”?
	\|type="[]"}		\|type="[]"}
	+normal mental status		+normal mental status

DrJeffRogers: /* Further Discussion */

2015-03-28T20:40:56Z

Further Discussion

← Older revision		Revision as of 20:40, 28 March 2015
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	*At Denver Health, this rule was demonstrated to be superior to the CHALICE and CATCH rules<ref>Easter J. et al. Comparison of PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury: A Prospective Cohort Study. Ann Emerg Med. 2014 Mar 10. PMID: 24635987</ref>		*At Denver Health, this rule was demonstrated to be superior to the CHALICE and CATCH rules<ref>Easter J. et al. Comparison of PECARN, CATCH, and CHALICE Rules for Children With Minor Head Injury: A Prospective Cohort Study. Ann Emerg Med. 2014 Mar 10. PMID: 24635987</ref>
	*The rarity of TBI in children was reinforced when analyzing those with isolated vomitting and no other positive factors on the decision rule<ref>Dayan, P. et al. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med. 2014 Jun;63(6):657-65. PMID: 24559605</ref>		*The rarity of TBI in children was reinforced when analyzing those with isolated vomitting and no other positive factors on the decision rule<ref>Dayan, P. et al. Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med. 2014 Jun;63(6):657-65. PMID: 24559605</ref>
			*For '''isolated scalp hematoma''' a sub analysis post-hoc analysis of the 2,998 patients with isolated scalp hematomas required a neurosurgical intervention. The risk of clinically important traumatic brain injury overall was less than 1 in 200. <ref>Dayan PS, et al. Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Ann Emerg Med. 2014 Aug;64(2):153-62. PMID: 24635991.</ref>

	==Funding==		==Funding==

Ostermayer at 16:25, 17 January 2015

2015-01-17T16:25:47Z

← Older revision		Revision as of 16:25, 17 January 2015
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	==External Links==		==External Links==
	*[http://www.aliem.com/vomiting-kids-head-trauma-ct/ ALiEM PECARN Vomitting]		*[http://www.aliem.com/vomiting-kids-head-trauma-ct/ ALiEM PECARN Vomitting]
			*[http://californiaacep.org/public-health/pecarn/ Cal ACEP PECARN Pocket cards]
	==Sources==		==Sources==
	<references/>		<references/>

	[[Category:EBQ]][[Category:Peds]][[Category:Featured]]		[[Category:EBQ]][[Category:Peds]][[Category:Featured]]