Mihindu Esther, Bhullar Indermeet, Tepas Joseph, Kerwin Andrew
Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.
Am Surg. 2014 Sep;80(9):841-3.
Pediatric Emergency Care Applied Research Network (PECARN) guidelines have a near 100 per cent negative predictive value for clinically important traumatic brain injury (ciTBI) in children with mild head injury (Glasgow Coma Score [GCS] 14 or 15). Our goal was to retrospectively apply their criteria to our database to determine the potential impact on the rates of unnecessary head computed tomography (CT) and ciTBI detection. The records of pediatric patients with GCS 14 to 15 that had a head CT for suspected TBI after blunt trauma from 2008 to 2010 were reviewed. Of 493 children, CT was negative in 447 (91%), but findings were present in 46 (9%). Applying PECARN recommendations, 178 (36%) met all six criteria but still underwent head CT; all were negative. The remaining 315 (64%) missed one or more PECARN criteria and underwent CT; only 46 (15%) had findings, and two (0.6%) required surgery. There were no false-negatives. The negative predictive value for ciTBI was 100 per cent. Observance of PECARN guidelines identifies children who do not require CT, increasing the yield of finding a ciTBI among those who cannot satisfy all six criteria.
儿科急诊护理应用研究网络（PECARN）指南对于轻度头部损伤（格拉斯哥昏迷评分[GCS]为14或15）的儿童中具有临床重要意义的创伤性脑损伤（ciTBI）的阴性预测值接近100%。我们的目标是回顾性地将其标准应用于我们的数据库，以确定对不必要的头部计算机断层扫描（CT）率和ciTBI检测的潜在影响。对2008年至2010年因钝性创伤疑似创伤性脑损伤而进行头部CT检查的GCS为14至15的儿科患者记录进行了回顾。在493名儿童中，447名（91%）的CT结果为阴性，但46名（9%）有阳性发现。应用PECARN建议，178名（36%）符合所有六项标准，但仍接受了头部CT检查；所有结果均为阴性。其余315名（64%）未满足一项或多项PECARN标准并接受了CT检查；只有46名（15%）有阳性发现，两名（0.6%）需要手术。没有假阴性结果。ciTBI的阴性预测值为100%。遵守PECARN指南可识别出不需要CT检查的儿童，从而提高在那些不能满足所有六项标准的儿童中发现ciTBI的检出率。
