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Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury

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Abstract

Purpose

Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) prognostic rules is a scoring system for prediction of the need for computed tomography (CT) scanning in children with mild TBI. However, its validation has not been assessed in developing countries. Therefore, the present study was designed to assess the value of PECARN rule in identification of children with clinically important TBI (ciTBI).

Method

In this prospective cross-sectional study, 594 children (mean age: 7.9 ± 5.3 years; 79.3% boys) with mild TBI brought to emergency ward of two healthcare centers in Tehran, Iran were assessed. PECARN checklist was filled for all patients and children were divided to three groups of low, intermediate and high risks. Patients were followed for 2 weeks by phone to assess their ciTBI status. At the end, discrimination power, calibration and overall performance of PECARN rule were assessed.

Results

PECARN had a sensitivity and specificity of 92.3 and 40.6%, respectively, in predicting ciTBI in children under 2 years and 100.0 and 57.8%, respectively, in individuals between the ages of 2 and 18. PECARN rule had a proper calibration in prediction of ciTBI and CT scan findings. Brier score (overall performance) of PECARN rule in predicting ciTBI in children under 2 and 2–18 years were 1.5 and 1.2, respectively.

Conclusion

PECARN prediction rule has a proper validity in the prediction of ciTBI. Therefor it can be used for screening and identification of high risk children with mild TBI.

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Acknowledgements

We appreciate the efforts by radiologists and emergency medicine physicians who collaborated with us in this study.

Author information

Authors and Affiliations

  1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran

    B. Nakhjavan-Shahraki

  2. Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran

    M. Yousefifard

  3. Department of Emergency Medicine, Hafte Tir Hospital, Iran University of Medical Sciences, Tehran, Iran

    M. J. Hajighanbari

  4. Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    A. Oraii

  5. Clinical Research Development Center, Amir-Almomenin Hospital, Islamic Azad University, Medical Sciences Branch, Tehran, Iran

    S. Safari

  6. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran

    M. Hosseini

Authors
  1. B. Nakhjavan-Shahraki
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  2. M. Yousefifard
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  3. M. J. Hajighanbari
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  4. A. Oraii
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  5. S. Safari
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  6. M. Hosseini
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Corresponding author

Correspondence to M. Hosseini.

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Conflict of interest

Babak Nakhjavan-Shahraki, Mahmoud Yousefifard, Mohammad Javad Hajighanbari, Alireza Oraii, Saeed Safari and Mostafa Hosseini declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the ethics committee of Tehran University of Medical Sciences. ll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Nakhjavan-Shahraki, B., Yousefifard, M., Hajighanbari, M.J. et al. Pediatric Emergency Care Applied Research Network (PECARN) prediction rules in identifying high risk children with mild traumatic brain injury. Eur J Trauma Emerg Surg 43, 755–762 (2017). https://doi.org/10.1007/s00068-017-0811-9

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  • DOI: https://doi.org/10.1007/s00068-017-0811-9

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