Kobe Isaac O, Qureshi Mahmoud M, Hassan Saidi, Oluoch-Olunya David L
Department of Surgery, The Aga Khan University Hospital, P.O BOX 30270-00100, Nairobi, Kenya.
Childs Nerv Syst. 2017 Dec;33(12):2147-2152. doi: 10.1007/s00381-017-3577-9. Epub 2017 Aug 30.
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.
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?"
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.
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%).
The number of head CT scans ordered reduced without missing any clinically significant traumatic brain injury.
对于为排除儿童轻度头部损伤中具有临床意义的创伤性脑损伤而进行头部CT扫描的决策，是基于临床决策规则做出的，其中已发现儿科急诊护理应用研究网络（PECARN）头部CT规则最为敏感。
本研究的目的是确定为轻度头部损伤儿童进行头部CT扫描的比例，并确定在引入PECARN头部CT规则后与之前时期相比，急诊患者的处置情况。研究问题是“引入PECARN头部CT规则是否会降低AKUHN医院为18岁以下轻度头部损伤儿童要求进行头部CT扫描的比例？”
采用前后对照的准实验研究，研究人群包括所有18岁以下因轻度头部损伤就诊于AKUHN且就诊时格拉斯哥昏迷量表评分为14分及以上的儿童。样本量为85。
研究前共分析了42份患者档案，研究后选取了43例患者。中位年龄为5岁。头部CT扫描的比例从研究前组的56%降至研究后组的33%，且没有漏诊任何具有临床意义的创伤性脑损伤。研究后组（81%）经评估后出院回家的患者比研究前组（58%）更多。
头部CT扫描的开具数量减少，且没有漏诊任何具有临床意义的创伤性脑损伤。
