du Plessis Jacques, Gounden Sharadini K, Lewis Carolyn
Department of Diagnostic Radiology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
Department of Emergency Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
SA J Radiol. 2022 Apr 14;26(1):2289. doi: 10.4102/sajr.v26i1.2289. eCollection 2022.
Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) aids clinicians in their decision-making processes whilst deciding whether a patient at very low risk of a clinically important TBI (ciTBI) requires a CT scan.
To establish whether the introduction of the PECARN CDR would affect CT utilisation rates for paediatric patients presenting with minor blunt head injuries to an academic hospital in Gauteng, South Africa.
This was an audit of paediatric patients who presented with minor blunt head injuries and were referred for CT imaging at an academic hospital in Gauteng, compared with PECARN CDR recommendations, over a 1-year period.
A total of 100 patients were referred for CT imaging. Twenty patients were classified as very low risk, none of whom had any CT findings of a TBI or ciTBI ( < 0.01). A total of 61 patients were classified as intermediate risk and 19 as high risk. In all, 23% of the intermediate and 47% of the high-risk patients had CT features of a TBI, whilst 8% and 37% had a ciTBI, respectively.
Computed tomography brain imaging may be omitted in patients classified as very low risk without missing a clinically important TBI. Implementing the PECARN CDR in appropriate patients would reduce CT utilisation rates.
创伤性脑损伤（TBI）是儿童发病和死亡的常见原因，在低收入和中等收入国家TBI发生率更高。非增强脑部CT是诊断颅内损伤的金标准；然而，它会使患者暴露于电离辐射中。儿科急诊护理应用研究网络（PECARN）临床决策规则（CDR）有助于临床医生在决定极低临床重要性TBI（ciTBI）风险的患者是否需要进行CT扫描时的决策过程。
确定引入PECARN CDR是否会影响南非豪登省一家学术医院中因轻度钝性头部损伤就诊的儿科患者的CT使用率。
这是一项针对因轻度钝性头部损伤就诊并在豪登省一家学术医院被转诊进行CT成像的儿科患者的审核，与PECARN CDR建议进行比较，为期1年。
共有100名患者被转诊进行CT成像。20名患者被分类为极低风险，其中无一例有TBI或ciTBI的CT表现（<0.01）。共有61名患者被分类为中度风险，19名被分类为高风险。总体而言，23%的中度风险患者和47%的高风险患者有TBI的CT特征，而分别有8%和37%的患者有ciTBI。
对于分类为极低风险的患者，可省略计算机断层扫描脑部成像，而不会遗漏临床重要的TBI。在合适的患者中实施PECARN CDR将降低CT使用率。
