Abstract
Background
The decision to order head CT scans to rule out clinically significant traumatic brain injury in mild head injury in children is made on the basis of clinical decision rules of which the Paediatric Emergency Care Applied Research Network (PECARN) CT head rules have been found to be most sensitive.
Purposes
The purpose of this study is to determine the proportion of head CT scans done for children with mild head injury and to determine disposition of patients from casualty after the introduction of PECARN head CT rules compared to the period before. The research question is “will introduction of the PECARN CT head rules reduce the proportion of head CT scans requested for children under 18 years with mild head injury at the AKUHN?”
Methods
A before and after quasi experimental study with a study population including all children under 18 years presenting to the AKUHN with mild head injury and a Glasgow coma scale of 14 and above on presentation. Sample size was 85.
Results
A total of 42 patients files were analysed in the before study while 43 patients were selected for the after study. The median age was 5 years. The proportion of head CT scans reduced from 56% in the before group to 33% in the after group with no missed clinically significant traumatic brain injury. More patients were discharged home after evaluation in the after group (81%) than in the before group (58%).
Conclusions
The number of head CT scans ordered reduced without missing any clinically significant traumatic brain injury.
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Acknowledgements
I wish to thank the Dissertation Committee members for their critical input for my study.
I also wish to thank the management, staff and faculty members of AKUHN, and my fellow residents for their invaluable input and for being a great source of support to me during my study.
I wish to acknowledge and thank the nurses and doctors at the paediatric casualty at the Aga Khan University Hospital for supporting me and assisting in data collection.
Thanks to Dr. Isaac Kihurani, a paediatrician, who gave me the idea for the study and Dr. Sheila Waa, a neuroradiologist, who encouraged me, having reviewed far too many normal head CT scans in children. My gratitude to the library staff, staff and as well as, Mrs. Kamanda Ciru for her support.
Financial support was obtained from the Aga Khan University Resident research fund upon approval by the Aga Khan University Hospital, Nairobi (AKUHN) Research and Ethics Committee. The funds were allocated to Dr. Isaac Kobe, the corresponding author. Parts of the study were presented as powerpoint in the Faculty Seminar Series presentation at the Aga Khan University Hospital as part of qualifying requirement for the corresponding authors’s Master of Medicine dissertation.
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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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Kobe, I.O., Qureshi, M.M., Hassan, S. et al. The impact of the introduction of PECARN head CT rules on the utilisation of head CT scans in a private tertiary hospital in Sub-Saharan Africa. Childs Nerv Syst 33, 2147–2152 (2017). https://doi.org/10.1007/s00381-017-3577-9
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DOI: https://doi.org/10.1007/s00381-017-3577-9