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.