RT Journal Article
T1 Evaluation of the PECARN rule for traumatic brain injury applied to infants younger than 3 months and creation of a modified, age-specific rule
A1 Alonso-Cadenas, Jose Antonio
A1 Calderon-Checa, Rosa Maria
A1 Rivas-Garcia, Aristides
A1 Duran-Hidalgo, Isabel
A1 Cabrero-Hernandez, Marta
A1 Ruiz-Gonzalez, Sara
A1 Perez-Garcia, Maria Jose
A1 De-Ceano-Vivas, Maria
A1 Delgado-Gomez, Pablo
A1 Antonon-Rodriguez, Miguel
A1 Moreno-Sanchez, Ruben
A1 Martinez-Hernando, Jose
A1 Munoz-Lopez, Cristina
A1 Ortiz-Valentin, Irene
A1 Jimenez-Garcia, Raquel
K1 Head injuries 
K1 Traumatic brain injuries 
K1 Infant 
K1  Emergency department
K1 Brain Injuries, Traumatic
AB 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.
PB Springer
SN 0340-6199
YR 2022
FD 2022-10-24
LK http://hdl.handle.net/10668/20219
UL http://hdl.handle.net/10668/20219
LA en
NO 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
DS RISalud
RD Apr 12, 2025