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Evaluation of the PECARN rule for traumatic brain injury applied to infants younger than 3 months and creation of a modified, age-specific rule

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2022-10-24

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Alonso-Cadenas, Jose Antonio
Calderon-Checa, Rosa Maria
Rivas-Garcia, Aristides
Duran-Hidalgo, Isabel
Cabrero-Hernandez, Marta
Ruiz-Gonzalez, Sara
Perez-Garcia, Maria Jose
De-Ceano-Vivas, Maria
Delgado-Gomez, Pablo
Antonon-Rodriguez, Miguel

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Springer
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Abstract

Infants <3 months with minor head trauma (MHT) are a particularly vulnerable group, though few studies have focused specifically on these patients. We aimed to evaluate the application of the PECARN prediction rule, designed for clinically important traumatic brain injury (ciTBI) in children <2 years, in infants <3 months, and create a specific prediction rule for this population. We conducted a prospective multicenter observational study in 13 pediatric emergency departments (PEDs) in Spain. The PECARN rule was applied to all patients. A new specific prediction rule for infants <3 months of age was created. The main outcome measures were (1) ciTBI, (2) TBI evidenced on computed tomography (CT) scan, and (3) isolated skull fracture (ISF). Telephone follow-up was conducted for all patients over the 4 weeks after the initial PED visit. Of 21,981 children with MHT, 366 (1.7%) were <3 months old, and 195 (53.3%) underwent neuroimaging, including 37 (10.1%) with CT scan. The sensitivity and negative predictive value (NPV) of the PECARN prediction rule for ciTBI were 100% (95% CI, 20.7–100) and 99.7% (95% CI, 98.4–100%), respectively. Of the 230 infants (62.8%) who met the PECARN low-risk criteria, none had ciTBI, 1 (0.4% overall, 95% CI, 0–2.4) had TBI on CT, and 2 (0.9% overall; 95% CI, 0.1–3.1) had an ISF. Among the 136 infants (37.2%) who did not meet the PECARN low-risk criteria, 1 (0.3% overall; 95% CI, 0–1.5) had ciTBI, 11 (8.1% overall; 95% CI, 4.1–14.0) had TBI on CT, and 18 (13.2% overall; 95% CI, 8–20.1) had an ISF. The sensitivity and NPV of the Spanish prediction rule for ciTBI were 100% (95% CI, 20.7–100) and 100% (95% CI, 98.4–100%), respectively. No infants in the registry developed complications during follow-up. Conclusion: The PECARN rule for infants <2 years old accurately identified infants <3 months old at low risk for ciTBI in our population, although the adapted Spanish rule presented here could be even more accurate.

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Craniocerebral Trauma
Brain Injuries, Traumatic
Emergency Service, Hospital
Skull Fractures
Neuroimaging

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Lactante
Tomografía
Valor Predictivo de las Pruebas
Lesiones Traumáticas del Encéfalo
Fracturas Craneales
Traumatismos Craneocerebrales

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Keywords

Head injuries , Traumatic brain injuries , Infant , Emergency department, Brain Injuries, Traumatic

Citation

Alonso-Cadenas JA, Calderón Checa RM, Rivas García A, Durán Hidalgo I, Cabrero Hernández M, Ruiz González S, et al. Evaluation of the PECARN rule for traumatic brain injury applied to infants younger than 3 months and creation of a modified, age-specific rule. Eur J Pediatr. 2023 Jan;182(1):191-200. doi: 10.1007/s00431-022-04661-y. Epub 2022 Oct 24. Erratum in: Eur J Pediatr. 2023 Jan;182(1):201