Use of the PECARN clinical decision guidelines as a predictor of an intracranial lesion in mild traumatic brain injury in the paediatric population of Tunja, Boyacá

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Carlos Mojica
Jesús Guillermo Gañan-Vesga
Hernán Camilo Arenas Correa

Abstract

Objective


Identify the usefulness of PECARN decision guidelines as a predictor of traumatic brain injury in mild head injury in the paediatric population of Tunja, Boyacá.


Methods and results


A retrospective 5 years observational, descriptive study was performed, using the medical records of 220 paediatric patients. The population was divided into groups of 0-24 months and 2-18 years. The PECARN clinical decision criteria were applied and its result was compared with the official interpretation of computed tomography of the brain. Parametric tests were performed to evaluate the performance of PECARN as a predictor of intracranial injury. There was a positive predictive association of PECARN, with a P=001, in the group of patients that were 2 years or older. However, in the group younger than 2 years old no relation was found with a P=.5. An increased of MHI was found in the male population and, the tendency to the increase cases of mild head injury as the patients were older.


Conclusions


In the population of 2 years or older, 28 brain computed tomographies were performed that could have been avoided according to the application of clinical decision rules PECARN, thus decreasing the radiation levels of these patients. A prospective multicentre study involving validation of PECARN is needed in the Republic of Colombia.


 

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How to Cite
Mojica, C., Gañan-Vesga, J. G., & Arenas Correa, H. C. (2016). Use of the PECARN clinical decision guidelines as a predictor of an intracranial lesion in mild traumatic brain injury in the paediatric population of Tunja, Boyacá. Pediatría, 49(3), 78–83. Retrieved from https://revistapediatria.org/rp/article/view/18
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Originals

References

1 Md. Laurence Ducharme-Crevier,Md. Mark Wainwright
Acute management of children with traumatic brain injury
Clinical Pediatric Emergency Medicine, vol. 16 (2015), pp. 1522-8401
48-64

2 T. Glass,R. Ruddy,E. Alpern,M. Gorelick,J. Callahan,L. Lee
traumatic brain injuries and computed tomography use in pediatric sports participants american
Journal of emergency medicine, 33 (2015), pp. 1458-1464

3 Head injury: Assessment and early management; NICE clinical guideline [Internet]; January 2013 [Citado en Junio 2016] disponble en: https://pathways.nice.org.uk/pathways/head-injury#content=view- inndex&path=view%3A/pathways/head-injury/head-injury-overview.xml


4 J. Easter,K. Bakes,J. Dhaliwal,M. Miller,E. Caruso,J. Haukoos
Comparison of pecarn, catch, and chalice rules for children with minor head injury: a prospective cohort study
annals of emergency medicine, volume64 (2014),

5 K. Hennelly,R. Mannix,L. Nigrovic,L. Lee,K. Thompson,M. Monuteaux
Pediatric traumatic brain injury and radiation risks: a clinical decision analysis
The journal of pediatrics, vol. 162 (2013), pp. 392-397

6 DANE – Estadísticas Vitales: Defunciones no fetales: Trauma Craneoencefálico, periodo 2008 a 2013.

7 N. Kuppermann,J. Holmes,P. Dayan,J. Hoyle,S. Atabaki,Holubkov Ral
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study
The lancet, 374 (2009), pp. 1160-1170

8 Martínez I, Alcalá P. “Manejo del traumatismo craneal pediátrico”; Protocolos diagnóstico-terapéuticos de Urgencias Pediátricas SEUP-AEP.

9 M. Wintermark,P. Sanelli,A. Anzai y,Tsiouris a,C. Whitlow
Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques
J Am Coll Radiol, 12 (2015), pp. e1-e14 http://dx.doi.org/10.1016/j.jacr.2014.10.014
Medline

10 C. Reyes,P. López,E. Rodríguez,J. León
Guía clínica del traumatismo craneoencefálico leve y moderado en Pediatría
Can Pediatr, 34 (2010), pp. 31-37

11 D. Muñoz-Santanach,V. Trenchs Sainz de la Maza,E. González,C. Luaces
Niños con traumatismo craneal leve en urgencias: ¿es necesaria la radiografía de cráneo en pacientes menores de 2 años?
Elsevier.es, 25 (2014), pp. 149-153

12 G. Medwid,G. Couri
How accurate are clinical decision rules for pediatric minor head injury?
Annals of emergency medicine, volume60 (2012), pp. 278-279

13 J. Franco,A. Victor
Traumatismo craneoencefálico leve en niños
Evid Act Pract Ambul., 2 (2013), pp. 78-79

14 S. Feng,M. Law,B. Huang,S. Ng,Z. Li,Q. Meng
Radiation dose and cancer risk from pediatric CT examinations on 64-slice CT: A phantom study
European Journal of Radiology, 76 (2010), pp. e19-e22 http://dx.doi.org/10.1016/j.ejrad.2010.03.005
Medline

15 M. Pearce,J. Salotti,M. Little,K. McHugh,C. Lee,K. Kim
Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study
Lancet, 380 (2012), pp. 499-505 http://dx.doi.org/10.1016/S0140-6736(12)60815-0
Medline

16 Velasco,M. Arribas,C. Valencia,N. Zamora,S. Fernández,A. Lobeiras
Compliance with the pecarn and aep guidelines in diagnostic approach of mild head trauma in patients younger than 24 months old. variability in the management of head trauma in emergency care
an pediatr (barc), 83 (2015), pp. 166-172

17 M. Salgado
¿Es útil la tomografía computada de cerebro en niños con traumatismo encefalocraneano leve?
Pract Ambul, 17 (2014), pp. 39-40

18 Adriana Wegner,F. Pamela Céspedes
Traumatismo Encefalocraneano en Pediatría
rev chil pediatr, 82 (2011), pp. 175-190

19 D. Nishijima,Z. Yang,M. Urbich,J. Holmes,M. Zwienenberg-Lee,J. Melnikow
Cost-effectiveness of the pecarn rules in minor head trauma
Annals of emergency medicine, volume65 (2015), pp. 72-87