Report generated with Calculate by QxMD at https://www.qxmd.com/calculate
Over 400 decision support tools available • get the app for iOS or Android at qx.md/calculate
The PECARN rule was developed to assist in decision making for neuroimaging in children with head trauma
Studies enrolled and analyzed 42412 children (derivation and validation totals 8502 and 2216 age <2 years and 25283 and 6411 ≥ 2 years respectively). The prediction rule had a negative predictive value of 100% (95% CI 99.7-100.0) and sensitivity of 100% (86.3-100.0) for clinically significant traumatic brain injury (cTBI) in children < 2 years of age. The prediction rule had a negative predictive value of 99.95% (99.81-99.99) and sensitivity of 96.8% (89.0-99.6) for clinically significant traumatic brain injury (cTBI) in children ≥ 2 years of age.
Kuppermann et al. have derived a clinical decision rule that has been externally validated to identify children with very low risk of cTBI. In these identified children, routine CT scanning is not necessary.
The risk of clinically significant traumatic brain injury is calculated as follows:
Variable & Associated Points
For children age ≥ 2 years old
Presence of any of the following high-risk features found 4.3% of children had clinically significant traumatic brain injury on neuroimaging
GCS ⤠14
Signs of basilar skull fracture
Altered mental status
Presence of any of the following features found 0.9% of children had clinical significant traumatic brain injury on neuroimaging
History of loss of consciousness
History of vomiting
History of severe headache
Severe mechanism of injury
Absence of any of those features found ≤ 0.05% of children had clinical significant traumatic brain injury on neuroimaging
References
Kuppermann, N., Holmes, J., Dayan, P., Hoyle, J., Atabaki, S., Holubkov, R., Nadel, F., Monroe, D., Stanley, R., Borgialli, D., Badawy, M., Schunk, J., Quayle, K., Mahajan, P., Lichenstein, R., Lillis, K., Tunik, M., Jacobs, E., Callahan, J., Gorelick, M., Glass, T., Lee, L., Bachman, M., Cooper, A., Powell, E., Gerardi, M., Melville, K., Muizelaar, J., Wisner, D., Zuspan, S., Dean, J. and Wootton-Gorges, S.
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.
Lancet. 2009; 374(9696), pp.1160-1170.
Schonfeld, D., Bressan, S., Da Dalt, L., Henien, M., Winnett, J. and Nigrovic, L.
Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice
Arch. Dis. Child. 2014; 99(5), pp.427-431.
Do you have an enquiry or suggestion? Get in touch with us through Twitter @QxMD, Facebook QxMD, or email contact@qxmd.com