Performance of Two Head Injury Decision Rules Evaluated on an External Cohort of 18,913 Children.

Adolescent Algorithms Brain Injuries, Traumatic / diagnosis Child Child, Preschool Clinical Decision Rules Cohort Studies Craniocerebral Trauma Humans Infant Tomography, X-Ray Computed
Accuracy Children Computed tomography Decision rule Head injury

Journal

The Journal of surgical research
ISSN: 1095-8673
Titre abrégé: J Surg Res
Pays: United States
ID NLM: 0376340

Informations de publication

Date de publication:
01 2020
Historique:
received: 22 02 2019
revised: 10 07 2019
accepted: 23 07 2019
pubmed: 24 8 2019
medline: 19 2 2020
entrez: 24 8 2019
Statut: ppublish

Résumé

The Pediatric Emergency Care Applied Research Network (PECARN) decision rule demonstrates high sensitivity for identifying children at low risk for clinically important traumatic brain injury (ciTBI). As with the PECARN rule, the Israeli Decision Algorithm for Identifying TBI in Children (IDITBIC) recommends proceeding directly to computed tomography (CT) in children with Glasgow Coma Score (GCS) <15. The aim was to assess the diagnostic accuracy of two clinical rules that assign children with GCS <15 at presentation directly to CT. Accuracy analysis for detecting ciTBI was performed on a multicenter cohort of children used in the Australasian Pediatric Head Injury Rules Study. The external cohort included 18,913 children; 1691 (8.9%) had CT scan, 160 had ciTBI, and 24 (0.13%) had neurosurgery. Applying IDITBIC and PECARN rules would have missed 11 and 1 ciTBI patients; respectively. All patients with missed injuries were classified as such based on a hospital stay of >2 d. None of these patients died, needed neurosurgery, or required ventilatory support. In children aged <2 y, sensitivity, specificity, positive predictive value and negative predictive value of IDITBIC and PECARN rule were 95.2%, 79.5%, 3.8%, and 99.9% and 100.0%, 59.1%, 2.0%, and 100.0%, respectively. In children ≥2 y, sensitivity, specificity, positive predictive value and negative predictive value of IDITBIC and PECARN rule were 92.4%, 75.3%, 3.1%, and 99.9% and 99.2%, 52.9%, 1.7%, and 100.0%, respectively. The two decision rules demonstrated high accuracy in identifying ciTBI. As a screening tool, the PECARN rule outperformed IDITBIC. The findings suggest that clinicians should strongly consider directing children with GCS <15 at presentation to CT scan.

Sections du résumé

BACKGROUND
The Pediatric Emergency Care Applied Research Network (PECARN) decision rule demonstrates high sensitivity for identifying children at low risk for clinically important traumatic brain injury (ciTBI). As with the PECARN rule, the Israeli Decision Algorithm for Identifying TBI in Children (IDITBIC) recommends proceeding directly to computed tomography (CT) in children with Glasgow Coma Score (GCS) <15. The aim was to assess the diagnostic accuracy of two clinical rules that assign children with GCS <15 at presentation directly to CT.
MATERIALS AND METHODS
Accuracy analysis for detecting ciTBI was performed on a multicenter cohort of children used in the Australasian Pediatric Head Injury Rules Study.
RESULTS
The external cohort included 18,913 children; 1691 (8.9%) had CT scan, 160 had ciTBI, and 24 (0.13%) had neurosurgery. Applying IDITBIC and PECARN rules would have missed 11 and 1 ciTBI patients; respectively. All patients with missed injuries were classified as such based on a hospital stay of >2 d. None of these patients died, needed neurosurgery, or required ventilatory support. In children aged <2 y, sensitivity, specificity, positive predictive value and negative predictive value of IDITBIC and PECARN rule were 95.2%, 79.5%, 3.8%, and 99.9% and 100.0%, 59.1%, 2.0%, and 100.0%, respectively. In children ≥2 y, sensitivity, specificity, positive predictive value and negative predictive value of IDITBIC and PECARN rule were 92.4%, 75.3%, 3.1%, and 99.9% and 99.2%, 52.9%, 1.7%, and 100.0%, respectively.
CONCLUSIONS
The two decision rules demonstrated high accuracy in identifying ciTBI. As a screening tool, the PECARN rule outperformed IDITBIC. The findings suggest that clinicians should strongly consider directing children with GCS <15 at presentation to CT scan.

Identifiants

DOI: 10.1016/j.jss.2019.07.090 PMID: 31442746
pubmed: 31442746
pii: S0022-4804(19)30581-5
doi: 10.1016/j.jss.2019.07.090
pii:
doi:

Types de publication

Evaluation Study Journal Article Multicenter Study Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

426-433

Informations de copyright

Copyright © 2019 Elsevier Inc. All rights reserved.

Auteurs

Itai Shavit (I)

Emergency Department, Rambam Health Care Campus, Ruth Children's Hospital, Haifa, Israel. Electronic address: itai@pem-database.org.

Ayelet Rimon (A)

Emergency Department, Tel Aviv Sourasky Medical Center, Dana-Dwek Children's Hospital, Tel Aviv University, Tel Aviv-Yafo, Israel.

Yehezkel Waisman (Y)

Emergency Department, Schneider Children's Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv-Yafo, Israel.

Meredith L Borland (ML)

Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia; Schools of Paediatrics and Child Health and Primary Aboriginal and Rural Healthcare, University of Western Australia, Crawley, Western Australia, Australia.

Natalie Phillips (N)

Child Health Research Centre, School of Medicine, University of Queensland, Centre for Children's Health Research, Queensland, Australia; Lady Cilento Children's Hospital, Children's Health Queensland, South Brisbane, Queensland, Australia.

Amit Kochar (A)

Emergency Department, Women's & Children's Hospital, North Adelaide, South Australia, Australia.

John A Cheek (JA)

Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia; Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Yuri Gilhotra (Y)

Child Health Research Centre, School of Medicine, University of Queensland, Centre for Children's Health Research, Queensland, Australia.

Jeremy Furyk (J)

Emergency Department, The Townsville Hospital, Townsville, Australia.

Jocelyn Neutze (J)

Kidzfirst Middlemore Hospital, Auckland, New Zealand.

Stuart R Dalziel (SR)

Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand; Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.

Mark D Lyttle (MD)

Murdoch Children's Research Institute, Parkville, Victoria, Australia; Emergency Department, Bristol Children's Hospital, Bristol, United Kingdom; Academic Department of Emergency Care, University of the West of England, Bristol, United Kingdom.

Sivia Bressan (S)

Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Women's and Child Health, University of Padova, Padova, Padua, Italy.

Susan Donath (S)

Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.

Stephen Hearps (S)

Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Ed Oakley (E)

Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.

Louise Crowe (L)

Murdoch Children's Research Institute, Parkville, Victoria, Australia.

Franz E Babl (FE)

Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adolescent › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Sciences de l'information › Méthodologies informatiques › Algorithmes › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Plaies et blessures › Traumatismes du système nerveux › Traumatismes cranioencéphaliques › Lésions encéphaliques › Lésions traumatiques de l'encéphale › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Enfant d'âge préscolaire › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Sciences de l'information › Informatique › Informatique médicale › Applications de l'informatique médicale › Techniques d'aide à la décision › Règles de décision clinique › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Plaies et blessures › Traumatismes du système nerveux › Traumatismes cranioencéphaliques › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Performance of Two Head Injury Decision Rules...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Tomographie › Tomographie à rayons X › Tomodensitométrie › Performance of Two Head Injury Decision Rules...