TY - JOUR
T1 - Validation of the PECARN head trauma prediction rules in Japan
T2 - A multicenter prospective study
AU - Ide, Kentaro
AU - Uematsu, Satoko
AU - Hayano, Shunsuke
AU - Hagiwara, Yusuke
AU - Tetsuhara, Kenichi
AU - Ito, Tomoya
AU - Nakazawa, Taichi
AU - Sekine, Ichiro
AU - Mikami, Masashi
AU - Kobayashi, Tohru
N1 - Funding Information:
The authors would like to thank physicians, nurses, and medical assistants in the participating centers for logistic support with patient recruitment and follow-up. This work was supported by the Foundation for Growth Science ( 26-44 ) and MEXT KAKENHI JP16K11436 .
PY - 2020/8
Y1 - 2020/8
N2 - Background: Head trauma in children is one of the most common causes for emergency department visits. Although most trauma cases are minor, identifying those patients who have clinically important traumatic brain injury (ciTBI) is challenging. The Pediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rules identifying children who do not require cranial computed tomography (CT) were validated and are used all over the world. However, these rules have not been validated with large cohort multicenter studies in Asia. Objectives: To investigate whether the PECARN rules can be safely applied to Japanese children. Methods: We conducted a multicenter, prospective, observational cohort study. We included children younger than 16 with minor head trauma (Glasgow Coma Scale ≥14) who presented to the six participating centers within 24 h of their injuries between June 2016 and September 2017. The primary analysis was set to calculate the negative predictive value of the patients with very low risk by the PECARN rules, compared with a preset threshold of 99.85%. Results: We included 6585 children of which 463 (7.0%) had head CT scans performed and 23 (0.35%) had ciTBI. There were two patients with ciTBI who were classified as very low risk. The negative predictive value, calculated as 99.96% (95%CI: 99.86–100.00; P =.019), was significantly superior compared with the preset threshold of 99.85%. Conclusions: The PECARN head trauma prediction rules seemed to be safely applicable to Japanese children. Further studies are needed to determine safety in hospitals where physicians do not have expertise in managing children.
AB - Background: Head trauma in children is one of the most common causes for emergency department visits. Although most trauma cases are minor, identifying those patients who have clinically important traumatic brain injury (ciTBI) is challenging. The Pediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rules identifying children who do not require cranial computed tomography (CT) were validated and are used all over the world. However, these rules have not been validated with large cohort multicenter studies in Asia. Objectives: To investigate whether the PECARN rules can be safely applied to Japanese children. Methods: We conducted a multicenter, prospective, observational cohort study. We included children younger than 16 with minor head trauma (Glasgow Coma Scale ≥14) who presented to the six participating centers within 24 h of their injuries between June 2016 and September 2017. The primary analysis was set to calculate the negative predictive value of the patients with very low risk by the PECARN rules, compared with a preset threshold of 99.85%. Results: We included 6585 children of which 463 (7.0%) had head CT scans performed and 23 (0.35%) had ciTBI. There were two patients with ciTBI who were classified as very low risk. The negative predictive value, calculated as 99.96% (95%CI: 99.86–100.00; P =.019), was significantly superior compared with the preset threshold of 99.85%. Conclusions: The PECARN head trauma prediction rules seemed to be safely applicable to Japanese children. Further studies are needed to determine safety in hospitals where physicians do not have expertise in managing children.
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U2 - 10.1016/j.ajem.2019.158439
DO - 10.1016/j.ajem.2019.158439
M3 - Article
C2 - 31522928
AN - SCOPUS:85072053109
VL - 38
SP - 1599
EP - 1603
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
SN - 0735-6757
IS - 8
ER -