Blunt Head Trauma in the Pediatric Emergency Care Applied Research Network (PECARN)

Reducing Head CT Use for Children With Head Injuries in a Community Emergency Department

“…be evaluated without a CT scan. 3 The PECARN guidelines identify multiple risk factors for ci-TBI for patients with minor head trauma (eg, severe mechanism of injury, loss of consciousness, palpable skull fracture). Among patients with no risk factors, the prediction rule has a high negative predictive value for ci-TBI of 100.0% for children <2 years old and 99.95% for children ≥2 years old.…”

“…However, with proper implementation of PECARN, the rate of missed ci-TBIs is low. 3,25 In addition, we evaluated only absolute CT scan rates and did not evaluate whether PECARN was appropriately used with each encounter, because this analysis was beyond the scope of this study. Glasgow Coma Scale scores were not available in the EMR for the majority of the included patients, and so we were unable to limit our study population to patients with only minor head injuries, and we were unable to compare the head injury severity in the preintervention and postintervention patient populations.…”

A Clinical Decision Rule for Cranial Computed Tomography in Minor Pediatric Head Trauma

“…Variation in practice with respect to CT of the child with minor head trauma persists. 36 Clinical decision rules seek to reduce variability in medical management by providing evidence-derived guidelines for clinical care, improving the overall efficacy of health care. 37,38 The Canadian CT Head Rule was developed to address variation in clinical management and neuroimaging in adult blunt head trauma, the effects of which are under investigation.…”

Risk Stratification to Decrease Unnecessary Diagnostic Imaging for Acute Appendicitis

“…Our method of population identification for the active and passive samples (asking the attending physician whether he or she is considering appendicitis) has been used successfully in previous studies of pediatric appendicitis and other types of studies. 26,27 However, there is a risk that this method may introduce bias (toward the null) by prompting the ED attending use the pathway.…”