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Insights from the Pediatric Emergency Care Applied Research Network

I will admit to a biased fondness for the project, as I participated as one small cog in the nascent operation many years ago while a research assistant at The Children’s Hospital of Philadelphia. Now, PECARN can only be described as an unqualified success, using its resources to enroll sample sizes large enough to capture rare events, informing our care of everything from traumatic brain injury to diabetic ketoacidosis. Because of the continued investment of time and energy by its stewards, PECARN continues to conduct and publish high-quality research.

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Featured

  PECARN Pediatric Head Injury/Trauma Algorithm

Predicts need for brain imaging after pediatric head injury. Note: This only applies to children with GCS scores of 14 or greater. The PECARN Pediatric Head Injury Prediction Rule is a well-validated clinical decision aid that allows physicians to safely rule out the presence of clinically important traumatic brain injuries, including those that would require neurosurgical intervention among pediatric head injury patients who meet its criteria without the need for CT imaging.

  PECARN Pediatric Intra-Abdominal Injury (IAI) Algorithm

Identifies children at very low risk of clinically important blunt abdominal injuries. Use in patients <18 years old presenting with blunt abdominal trauma within 24 hours of injury. Do not use in patients with penetrating trauma, pre-existing neurologic disorders impeding a reliable exam, or pregnancy. Do not use in patients transferred from another hospital where abdominal CT or diagnostic peritoneal lavage was already performed.

  PECARN Rule for Low Risk Febrile Infants 29-60 Days Old

Predicts risk of urinary tract infection, bacteremia, or bacterial meningitis in febrile infants age 29-60 days old. This calculator is not yet externally validated. While derived in infants aged 0-60 days, the creators recommend using this calculator only in infants aged 29-60 days (i.e., do not use in infants 28 days or younger), due to elevated herpes meningoencephalitis risk and and limited numbers of episodes of bacterial meningitis in that age group (see Pearls/Pitfalls and Creator Insights for details).

 PECARN Pediatric Head Trauma: Official Visual Decision Aid for Clinicians

The Pediatric Emergency Care Applied Research Network (PECARN) collaborative has teamed up with the ALiEM and CanadiEM teams to introduce the official PECARN visual decision rule aid for pediatric blunt head trauma! This has been a 6 month collaboration focused on bringing evidence-based research to the bedside in pediatric emergency medicine (EM).

Articles of Interest

PECARN Spotlight: Tools Validated

In this episode, we delve into a pivotal multi-center study validating the Pediatric Emergency Care Applied Research Network (PECARN) prediction rules for using CT imaging in children with blunt abdominal and minor head trauma. We discuss with the authors the study’s impact, how these validated rules can optimize pediatric trauma care, minimize radiation risks, and what this means for emergency practices worldwide. This conversation not only sheds light on the study’s intricate processes and outcomes, but also emphasizes the vital role of evidence-based guidelines in enhancing patient safety and care quality.

PECARN: Its relevance and importance in pediatric emergency care

Did you know that many of the landmark pediatric emergency medicine (EM) studies come from the Pediatric Emergency Care Applied Research Network (PECARN) collaborative? It works to address the challenging pediatric questions that only multicenter studies can.

Accuracy of Pediatric Emergency Care Applied Research Network Rules in Predicting Brain Injuries

According to the results of the present study, PECARN rules have a significant association with brain CT scan findings. Therefore, using these rules is recommended to reduce the number of brain CT scan requests for pediatric patients.

Are Pediatric Emergency Care Applied Research Network Rules (PECARN) Sufficient for Computed Cranial Tomography Decision in Pediatric Patients with Mild Head Trauma?

Because CCT poses serious radiation expo­sure, neurological examination and clinical follow-up should be preferred in the evaluation of children with MHT. In con­clusion, PECARN rules were sufficient for CCT decision in pediatric patients with MHT.

EB Medicine - PECARN Pediatric Head Injury/Trauma Algorithm

The PECARN Pediatric Head Injury Prediction Rule is a well-validated clinical decision aid that allows physicians to safely rule out the presence of clinically important traumatic brain injuries.

Multicenter Collaborative Research in Pediatric Emergency Care

PECARN consists of four research node centers (RNCs) located at diverse sites across the country.

The Effect of PECARN Guidelines on Minor Head Injury from the Urgent Care Center to the Emergency Room

While this study did not show a statistically significant change in the number of head injury patients sent to the emergency department after the evidence-based intervention, it is unclear whether the findings are able to be generalized to all urgent cares. Since this study did not specifically evaluate “appropriateness” of referrals, we recommend further study.

To Scan or Not to Scan? PECARN for Pediatric Head Trauma.

The Pediatric Emergency Care Applied Research Network (PECARN) head trauma clinical decision tool has been validated numerous times by external studies and has repeatedly been shown to have a sensitivity nearing 100% for clinically significant TBI when any of the six factors are present. The Children’s Head injury Algorithm for the prediction of Important Clinical Events (CHALICE) and The Canadian Assessment of Tomography for Childhood Head Injury (CATCH)are similar clinical predictor tools to PECARN, however both have a more limited age range (< 16 years old), lower sensitivity than PECARN, and are not as widely validated as PECARN.

Two decades of PECARN power

As a pediatric emergency medicine physician in the 1990s, Nate Kuppermann, M.D., M.P.H., could only dream of uniting hospitals across the country to improve the health of children in life-and-death situations. That type of network didn’t then exist in the U.S. What did exist was essentially a volunteer group of pediatric emergency physicians, organized in the American Academy of Pediatrics. Kuppermann’s collaborators, which included his wife and fellow UC Davis Health physician Nicole Glaser, M.D., were performing simple chart-review studies on shoestring budgets.

Resources

PECARN

PECARN is the Pediatric Emergency Care Applied Research Network, the first federally-funded multi-institutional network for research in pediatric emergency medicine in the United States.

PECARNteam

Where you can find all things #PECARN. Follow to learn about our multi-institutional research and #authorinsights. #PEM #EM #FOAMed RT ≠ endorsements