Evaluation of the PECARN rule for traumatic brain injury applied to infants younger than 3 months and creation of a modified, age-specific rule

医学 儿科 伤害预防 自杀预防 人为因素与人体工程学 职业安全与健康 毒物控制 医疗急救 病理
作者
José Antonio Alonso‐Cadenas,Rosa María Calderón Checa,Arístides Rivas García,Isabel Durán Hidalgo,Marta Cabrero Hernández,Sara Ruiz González,María José Pérez García,María de Ceano-Vivas,Pablo Delgado Gómez,Miguel Antoñón Rodríguez,Rubén Moreno Sánchez,José Martínez Hernando,Cristina Muñoz López,Irene Ortiz Valentín,Rodrigo Jiménez‐García
出处
期刊:European Journal of Pediatrics [Springer Science+Business Media]
卷期号:182 (1): 191-200 被引量:1
标识
DOI:10.1007/s00431-022-04661-y
摘要

Infants < 3 months with minor head trauma (MHT) are a particularly vulnerable group, though few studies have focused specifically on these patients. We aimed to evaluate the application of the PECARN prediction rule, designed for clinically important traumatic brain injury (ciTBI) in children < 2 years in infants < 3 months, and create a specific prediction rule for this population. We conducted a prospective multicenter observational study in 13 pediatric emergency departments (PEDs) in Spain. The PECARN rule was applied to all patients. A new specific prediction rule for infants < 3 months of age was created. The main outcome measures were (1) ciTBI, (2) TBI evidenced on computed tomography (CT) scan, and (3) isolated skull fracture (ISF). Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 21,981 children with MHT, 366 (1.7%) were < 3 months old and 195 (53.3%) underwent neuroimaging, including 37 (10.1%) with CT scan. The sensitivity and negative predictive value (NPV) of the PECARN prediction rule for ciTBI were 100% (95% CI, 20.7–100) and 99.7% (95% CI, 98.4–100%), respectively. Of the 230 infants (62.8%) who met the PECARN low-risk criteria, none had ciTBI, 1 (0.4% overall, 95% CI, 0–2.4) had TBI on CT, and 2 (0.9% overall; 95% CI, 0.1–3.1) had an ISF. Among the 136 infants (37.2%) who did not meet the PECARN low-risk criteria, 1 (0.3% overall; 95% CI, 0–1.5) had ciTBI, 11 (8.1% overall; 95% CI, 4.1–14.0) had TBI on CT, and 18 (13.2% overall; 95% CI, 8–20.1) had an ISF. The sensitivity and NPV of the Spanish prediction rule for ciTBI were 100% (95% CI, 20.7–100) and 100% (95% CI, 98.4–100%), respectively. No infants in the registry developed complications during follow-up. Conclusion: The PECARN rule for infants < 2 years old accurately identified infants < 3 months old at low risk for ciTBI in our population, although the adapted Spanish rule presented here could be even more accurate.
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