Adapted PECARN head Injury rule Is Safe and Effective

A modified PECARN head injury rule had good staff adherence and identified all patients with clinically important brain injuries.

In an observational before–after study at a tertiary pediatric emergency department in Italy, investigators evaluated adapted Pediatric Emergency Care Applied Research Network (PECARN) head injury rules for children younger than 15 years (see table). Before implementation, patients were risk-stratified according to a previously established protocol that differed from the PECARN rules by including presence of Glasgow Coma Scale score 12 or a two-point drop in score since arrival, focal neurological signs, or loss of consciousness for more than 5 minutes. The PECARN rules were adapted by inclusion of amnesia and more than five episodes or 6 hours of vomiting for patients <2 years of age; for all patients, those not undergoing head computed tomography (CT) were observed for at least 6 hours (at least 12 hours for those <6 months of age).

The 6-month pre- and postimplementation phases, respectively, included 288 and 356 patients younger than 15 years (overall median age, 2.4 years; 45% younger than 2 years). Use of CT was similar during the two phases (7.3% and 8.4%), as was detection of intracranial injuries (0.7% and 1.4%). Clinically important traumatic brain injuries (death, neurosurgery, intubation for >24 hours, or hospitalization for at least 2 nights) were identified in two patients before implementation and three after. The adapted PECARN rules achieved 94% adherence and high staff satisfaction and were rated significantly easier to use than the preimplementation protocol. With the adapted PECARN rules, 92% of patients without clinically important traumatic brain injuries did not undergo head CT and all three patients with such injuries underwent head CT.

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