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What are PECARN Rules? Hint: They Don’t Involve Nuts

Deciding when to order a CT scan in the case of a head injury can be a frustrating process. Yes, the likelihood of a serious finding is often low, but do you really want to be wrong when it comes to a head injury? Absolutely not- the stakes are too high. In kids, the CT decision becomes an even riskier process. Ordering a CT scan unnecessarily increases risk of radiation-related malignancy later in life. Enter the PECARN rules. Fortunately, there is a highly reliable, easy to use algorithm that helps medical providers determine when a CT scan is necessary in pediatric head trauma. No more ordering head scans on a whim, the Pediatric Emergency Care Applied Research Network (PECARN), a hub of…

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  PECARN Head CT Rule

Predicts need for brain imaging after pediatric head injury. Although the largest trial of its kind, the PECARN study had low rates of TBI on Head CT (5.2%) and even lower rates of ciTBI (0.9%) – this suggests overall TBI in children is rare! Head CTs were obtained in approximately 35% of patients, lower than the average estimate of 50%!

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

Of these tools, PECARN had the highest sensitivity with 100% and 99.0% in children 2 years and under, and 2-18 years old respectively. CATCH had a sensitivity of 95.2%, and CHALICE had a sensitivity of 92.3% (9).

Articles of Interest

Comparison of PECARN, CATCH, and CHALICE clinical decision rules for pediatric head injury in the emergency department

The results of this study provide external validation of the PECARN, CATCH, and CHALICE clinical decision rules. Application of the PECARN clinical decision rule resulted in the fewest missed patients with cTBI. The analysis of the comparison cohort suggests that the PECARN rule had a higher sensitivity for identifying cTBI; however, the 95% confidence intervals of all three rules overlapped, and none could be deemed superior.

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department

PECARN minor head trauma rules’ implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged < 2 years at low risk of ciTBI. The intervention did not increase the number of missed ciTBI.

New study validates PECARN prediction rules for CT imaging in pediatric trauma patients

“This study is a significant step forward in improving the quality of care for children in emergency settings,” Dr. Adelson said. “By reducing unnecessary CT scans, we can protect our young patients from the risks associated with radiation exposure while ensuring they receive the appropriate care.”

PECARN algorithms for minor head trauma: Risk stratification estimates from a prospective PREDICT cohort study

The risk estimates of ciTBI for each of the PECARN algorithms risk group were consistent with the original PECARN study.

PECARN Head CT Rule

The rule is unidirectional. If a child meets none of the criteria, a head CT can be safely avoided. However, if a child meets one or more criteria, that does not automatically mandate a head CT. There are low and high risk criteria that can help with this decision: Children with GCS <14 were excluded because the risk of TBI in CT is 20% and outweighs any risk of radiation exposure.

PECARN Rule in diagnostic process of pediatric patients with minor head trauma in emergency department

We demonstrated the safety and validity of the PR in our setting with 100% sensitivity in both age groups in identifying patients with ciTBI and theoretically in reducing performed CT scans by 29%. Therefore, in patients classified in the low-risk category, it is a duty not to expose the child to ionizing radiation.

Pediatric Minor Head Injury and Concussion

Our experts recommend using PECARN in patients with GCS 14-15 in whom your gestalt is that they do not require a CT scan and using CATCH2 in patients with a GCS of 13 in whom your gestalt is that they do require a CT scan.

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RUSH Emergency Medicine Education

It excluded patients with trivial injury, penetrating trauma, neurologic history, and those with prior imaging. The outcomes this study aimed for were clinically important findings including death, need for neurosurgical intervention, intubation >24 hours, and admission >2 nights.