Actualisation des recommandations pour la prise en charge du traumatisme crânien léger chez l’enfant

Lorton, Fleur; Levieux, Karine; Vrignaud, Bénédicte; Hamel, Olivier; Jehle, E. C.; Hamel, A.; Gras-Leguen, C.

doi:10.1016/j.arcped.2014.04.015

Cited by 11 publications

(21 citation statements)

References 11 publications

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“…Appropriate validation requires a prospective assessment of rule performances in multiple clinical settings, aside from the derivation study. The French Emergency Medicine Society (SFMU) and the Francophone Group of Pediatric Resuscitation and Emergency (GFRUP) have been recommending the PECARN rule since 2012 for the management of MHT in children [14, 15]. The authors emphasized the need, however, to conduct an external validation study of this CDR.…”

Section: Introductionmentioning

confidence: 99%

Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study

Lorton

Poullaouec²,

Legallais³

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundTo date, the Pediatric Emergency Care Applied Research Network (PECARN) rule for identifying children who are at very low risk of clinically-important traumatic brain injuries after minor head trauma has not been validated prospectively in an independent population. Our goal was to evaluate the diagnostic performance of the PECARN clinical decision rule in a French pediatric population in multiple clinical settings.MethodsWe conducted a multicenter, prospective, non-interventional cohort study of patients with minor head trauma who presented to three emergency departments in France. We enrolled patients younger than 16 years of age seeking a consultation within 24 h of head trauma with Glasgow Coma Scale scores of 14–15.ResultsDuring the study period, we included 1499 children of which 421 (28 %) were under 2 years of age, and 955 (64 %) were male. A cranial computed tomography (CT) scan was performed on 76 patients (5.1 %). Of the 1499 included patients, 9 children (0.6 %) had a clinically-important traumatic brain injury, and none were classified as very low risk by the PECARN rule. In our study, the sensitivity of this clinical decision rule was 100 % (95 % CI 66.4 to 100 %), the specificity was 69.9 % (95 % CI 67.5 to 72.2 %) and the negative predictive value was 100 % (95 % CI 99.7 to 100 %).DiscussionOur study confirmed the good predictive performances of the PECARN clinical decision rule for minor head trauma in children. The PECARN rule performed similarly to our study and to its internal validation study.ConclusionsWe conducted an external validation study of the PECARN clinical decision rule for the detection of clinically-important traumatic brain injuries in children with minor head trauma, according to the methodological standards. The PECARN rule successfully identified all patients with clinically-important traumatic brain injuries, with a limited use of CT scans. Conducting a broad validation study with a large cohort is a prerequisite to provide sufficient statistical power before authorizing its implementation and generalization.Trial registrationThis study has been registered in ClinicalTrials.gov with identifier number: NCT02752711 on April 27, 2016.

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Section: Introductionmentioning

confidence: 99%

Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study

Lorton

Poullaouec²,

Legallais³

et al. 2016

Scand J Trauma Resusc Emerg Med

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“…Les traumatismes crâniens mineurs (TCM) sont fréquents en pédiatrie qui et ont fait récemment l'objet d'une actualisation des recommandations en France [1]. En pratique sportive des commotions cérébrales secondaires à un TCM sont souvent rapportées alors que les lésions cérébrales graves avec hémorragie intra-crânienne sont plus rares.…”

Section: Introductionunclassified

“…permet de juger de l'opportunité d'une imagerie et d'une hospitalisation, selon les recommandations en vigueur[1]. En cas de commotion cérébrale, une période de repos psychique de 24-48 heures et un retour progressif à l'exercice physique et intellectuel doivent être proposés.…”

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“…Ce caractère progressif du retour à la normale est essentiel. Il pourrait être détaillé sur la fiche d'information qu'il est proposé de remettre aux parents après un TCM[1].Le Tableau III résume l'approche graduelle de reprise physique jusqu'au retour sur le terrain.Chez l'enfant de moins de 19 ans, le retour sur le terrain n'est pas permis avant un délai de 3 semaines. Chez l'adulte de plus de 20 ans, la date de retour sur le terrain dépend de la durée des signes reliés à l'épisode initial, selon la classification de Cantu : présence d'une perte de connaissance initiale et sa durée, durée des symptômes initiaux (< 30 minutes, 30 minutes-24 heures ou > 24 heures), antécédents de commotion cérébrale dans l'année.…”

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Commotions cérébrales chez le jeune sportif

Minodier

Guillaume

Coudreuse

et al. 2015

Archives de Pédiatrie

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“…De esta manera, en España existe la guía clínica de la AEP pero observamos cómo muchos de los centros españoles no siguen sus recomendaciones, aspecto que debería plantear la modificación y actualización de sus protocolos (173). Otros países con guías clínicas de manejo elaboradas por sus sociedades nacionales son Italia, Reino Unido, Francia y Holanda (192)(193)(194). Hungría y Turquía, en cambio, no tienen protocolos de manejo del TCE, y son en estos centros en los que se realizan, por ejemplo, un mayor porcentaje de radiografías de cráneo.…”

Section: Análisis De La Variabilidadunclassified

Traumatismo craneoencefálico leve pediátrico en Europa

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Actualisation des recommandations pour la prise en charge du traumatisme crânien léger chez l’enfant

Cited by 11 publications

References 11 publications

Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study

Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study

Commotions cérébrales chez le jeune sportif

Traumatismo craneoencefálico leve pediátrico en Europa

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