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Abstract
Aim To assess if inappropriate CT scans are being performed, and whether PECARN (Paediatric Emergency Care Applied Research Network) guidelines could be used to identify patients for whom CT Brain could be safely omitted.
Methods All children less than 16 years who presented with head injury in 2014 were identified through the HIPE system. A chart review identified the number and clinical indications for CT Brain. In addition, we recorded the risk category met according to PECARN guidelines and the outcome of each case.
Results For the study period 53 children under the age of 16 were admitted to the Emergency Department with head injuries. Of these 22% were under the age of 2 years. Overall CT Brain rate was 41% and clinically important Traumatic Brain Injury (ciTBI) occurred in 1 patient (2.4%).
12 patients under 2 years were identified with charts available for 11. 82% met the PECARN inclusion criteria.
43 patients between 2–16 years were identified, with 42 charts available. 78% met the PECARN inclusion criteria.
Conclusion Of the 3 recognised Clinical Decision Rules regarding CT Brain in children, PECARN, CATCH and CHALICE, from which the 2007 NICE guidelines were derived, PECARN is the only validated study. PECARN has also been shown to be the only study with a very high level of sensitivity for ciTBI (100%; 95% CI 84%–100%) although CHALICE is applicable to a higher proportion of patients.
4 of 7 children in the PECARN Low Risk category had unnecessary CT Brain performed. The introduction of PECARN guidelines could be a safe way to reduce the inappropriate use of CT Brain for those who meet the inclusion criteria.