Rivero Rachel, Curran Isabelle L, Hellmann Zane, Carroll Madeleine, Hornick Matthew, Solomon Daniel, DiLuna Michael, Morrell Patricia, Christison-Lagay Emily
Department of Surgery, New Haven, CT 06510, USA; Yale University School of Medicine, New Haven, CT 06510, USA.
Department of Surgery, New Haven, CT 06510, USA; Yale University School of Medicine, New Haven, CT 06510, USA.
J Pediatr Surg. 2025 Feb;60(2):162097. doi: 10.1016/j.jpedsurg.2024.162097. Epub 2024 Dec 10.
The Pediatric Emergency Care Applied Research Network (PECARN) guidelines provide an algorithm to select patients with mild head trauma at highest risk for clinically important traumatic brain injury (ciTBI) in whom computed tomography (CT) would facilitate management. Failure to follow PECARN criteria exposes children to unnecessary radiation and contributes to increasing hospital costs, length of stay, and parental anxiety. We sought to evaluate the subsequent allocation of resources to low and intermediate risk group patients who underwent an initial Head CT - which was not indicated by PECARN guidelines but which identified cranial or intracranial injury.
We conducted a retrospective review of children ≤16 years old with head injury (GCS ≥14) between 2016 and 2021. Children with neurological deficits, penetrating head trauma, anticoagulation, or non-accidental trauma were excluded. Demographics, imaging results, PECARN risk category, and need for neurosurgical intervention were collected.
There were 70 low risk patients who had positive findings on CT, however none demonstrated clinically significant progression on repeat imaging that necessitated medical or surgical intervention. Of 319 intermediate risk patients with evidence of skull fracture or intracranial injury on CT, only one required intervention. The decision to intervene was made based on clinical changes and was not influenced by repeat imaging.
Despite PECARN guidelines, cross-sectional imaging remains overused. Identification of small foci of clinically non-actionable intracranial bleeding in patients who do not meet initial PECARN criteria frequently prompts further cross-sectional imaging without benefit. This suggests that routine interval imaging may not be necessary in the neurologically stable child with low-risk injury.
Retrospective cohort study.
Level III.
儿科急诊护理应用研究网络（PECARN）指南提供了一种算法，用于选择轻度头部创伤且临床上发生重要创伤性脑损伤（ciTBI）风险最高的患者，计算机断层扫描（CT）有助于对此类患者进行管理。不遵循PECARN标准会使儿童遭受不必要的辐射，并导致医院成本增加、住院时间延长以及家长焦虑。我们试图评估对低风险和中风险组患者后续的资源分配情况，这些患者接受了首次头部CT检查——这不符合PECARN指南的指征，但却发现了颅骨或颅内损伤。
我们对2016年至2021年间16岁及以下头部受伤（格拉斯哥昏迷量表评分≥14）的儿童进行了回顾性研究。排除有神经功能缺损、穿透性头部创伤、抗凝或非意外创伤的儿童。收集人口统计学数据、影像学结果、PECARN风险类别以及神经外科干预需求。
70名低风险患者CT检查结果呈阳性，但重复成像均未显示有需要医疗或手术干预的临床显著进展。在319名CT显示有颅骨骨折或颅内损伤证据的中风险患者中，只有1人需要干预。干预决策是基于临床变化做出的，不受重复成像的影响。
尽管有PECARN指南，但横断面成像仍被过度使用。在不符合初始PECARN标准的患者中发现临床上无需采取行动的颅内小出血灶，常常会促使进行进一步的横断面成像，而并无益处。这表明，对于神经功能稳定的低风险受伤儿童，可能无需进行常规的间隔成像。
回顾性队列研究。
三级。
