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

Abstract

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.

Does my child really need a CT Scan? A retrospective review of use of CT Scan in minor head trauma

“…The validation of (PECARN) was not validated in middle east country before. Our study confirmed the good predictive performances of the PECARN clinical decision rule for minor head trauma in children similar to the previous French study [3,4].…”

Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study

“…An earlier retrospective Canadian study showed CTB rates of 6–26% (15% overall). Lower rates have been described in other countries although limited published data are available on interhospital variation . Results from the APHIRST study demonstrate that clinicians at our centres are missing very few significant injuries, suggesting that the imaging rate is not inappropriately low.…”

“…Lower rates have been described in other countries although limited published data are available on interhospital variation. 7,[21][22][23][24] Results from the APHIRST study 15,25 demonstrate that clinicians at our centres are missing very few significant injuries, suggesting that the imaging rate is not inappropriately low. Imaging rates were also considerably lower than theoretical imaging rates would be if each of the CDRs examined in APHIRST were applied strictly as a rule, 15 highlighting the importance of considering CDRs as a tool, rather than a rule per se.…”

External Validation of the PECARN Head Trauma Prediction Rules in Japan

“…In the United States, the Pediatric Emergency Care Applied Research Network (PECARN) developed two age‐based head trauma prediction rules to identify children at low risk of clinically important traumatic brain injury (ciTBI) who do not require head CT . The PECARN rules were validated in North America and Europe and have since been used to assist CT decision‐making for children with minor head trauma . However, the PECARN rules have not yet been validated in Asia.…”