Silvia Bressan1, Paola Berlese2,3, Marta Arpone2, Ivan Steiner4, Luigi Titomanlio3, Liviana Da Dalt2. 1. Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padova, Italy. silvia.bressan.1@unipd.it. 2. Division of Pediatric Emergency Medicine, Department of Women's and Children's Health, University of Padova, Via Giustiniani 3, 35128, Padova, Italy. 3. Pediatric Emergency Department, Robert Debré Hospital, Paris, France. 4. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
Abstract
PURPOSE: The PECARN head trauma (HT) prediction rules have been developed to guide computed tomography-related decision-making for children with minor HT (mHT). There are currently limited data on the rate of unscheduled revisits to emergency departments (EDs), and initially missed intracranial injuries, in children with mHT initially assessed using the PECARN rules. This study aimed to fill this gap in knowledge. METHODS: Clinical charts of children assessed for mHT over a 5-year period at two EDs that implemented the PECARN rules in Italy and France were reviewed retrospectively. Children who returned to EDs for mHT-related, or potentially related complaints, within 1 month of initial assessment were included. RESULTS: The total number of children with mHT presenting for the first time to the EDs of both sites was 11,749. Overall, 180 (1.5%) unscheduled revisits to the EDs occurred for mHT-related or potentially related complaints. Twenty-three of these 180 patients underwent neuroimaging, and seven had an intracranial injury (including one ischemic stroke). Of these, three were hospitalized and none needed neurosurgery or intensive care. CONCLUSION: Unscheduled revisits for mHT in EDs using the PECARN rules were very uncommon. Initially missed intracranial injuries were rare, and none needed neurosurgery or intensive care.
PURPOSE: The PECARN head trauma (HT) prediction rules have been developed to guide computed tomography-related decision-making for children with minor HT (mHT). There are currently limited data on the rate of unscheduled revisits to emergency departments (EDs), and initially missed intracranial injuries, in children with mHT initially assessed using the PECARN rules. This study aimed to fill this gap in knowledge. METHODS: Clinical charts of children assessed for mHT over a 5-year period at two EDs that implemented the PECARN rules in Italy and France were reviewed retrospectively. Children who returned to EDs for mHT-related, or potentially related complaints, within 1 month of initial assessment were included. RESULTS: The total number of children with mHT presenting for the first time to the EDs of both sites was 11,749. Overall, 180 (1.5%) unscheduled revisits to the EDs occurred for mHT-related or potentially related complaints. Twenty-three of these 180 patients underwent neuroimaging, and seven had an intracranial injury (including one ischemic stroke). Of these, three were hospitalized and none needed neurosurgery or intensive care. CONCLUSION: Unscheduled revisits for mHT in EDs using the PECARN rules were very uncommon. Initially missed intracranial injuries were rare, and none needed neurosurgery or intensive care.
Entities:
Keywords:
Clinical predictive rule; Minor head trauma; Missed brain injury; Return visit
Authors: Sooje Cho; Soyun Hwang; Jae Yun Jung; Young Ho Kwak; Do Kyun Kim; Jin Hee Lee; Jin Hee Jung; Joong Wan Park; Hyuksool Kwon; Dongbum Suh Journal: PLoS One Date: 2022-01-18 Impact factor: 3.240