Introduction
Head injuries in children are a common cause of emergency department visits. More than 95 % of these constitute minor head trauma (MHT), defined as Glasgow Coma Scale (GCS) score greater than or equal to 13. Among these patients, less than 10 % have traumatic brain injuries (TBI), and less than 1 % need neurosurgery1,2. The uncertainty about these injuries’ management increases cranial CT usage in pediatric emergency departments (PEDs), increasing the risk of ionizing radiation in children. From 1996 to 2008, CT use for pediatric patients presenting to the ED with head injury increased from 10.9% to 34.0%.3. Unnecessary radiologic testing utilization increases costs, increases the length of stay and may cause iatrogenic cancer in 1:1500 to 1:3000 pediatric patients 4-6. Such children’s management poses a difficulty for emergency physicians to balance the need for head computed tomography (CT) scan for intracranial injury (ICI) identification on the one hand and limiting the radiation associated risks on the other. An effective Clinical Decision Support Tool (CDST) is necessary to identify traumatic brain injuries (TBI) to optimize the risk of radiation exposure. There have been eight CDSTs identified7for children with a mild head injury, and Pediatric Emergency Care Applied Research Network (PECARN) clinical decision rule have been one of the most effective used decision tool in reducing the use of CT in pediatric patients with minor blunt head trauma (MBHT). PECARN was first published in 2009 by Dr. Nathan Kuppermann as a clinical prediction rule for identifying children at very low risk of clinically significant traumatic brain injuries (ciTBI) and for reducing CT use because of malignancy induced by ionizing radiation1. The decision tool was designed separately for two age groups of children younger than 2 years old and 2 to 18 years old with a classification of low, moderate, and high-risk patients. For patients belonging to the low-risk category, the PECARN rule does not recommend a head CT. Kuppermann et al. were successful in proving the internal validity of the PECARN decision tool. Various pediatric EDs have independently or compared with other CDSTs [8-10] have conducted studies to rule out the validation of PECARN head injury guidelines in the past, and researchers showed that application of the PECARN rule could reduce up to 58.3% of unnecessary CT scans1. The present study is a meta-analysis of the studies from 2009 to 2020 for the PECARN decision rule’s accuracy in children with a very low risk of blunt head trauma.