Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit
Background: Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paedia...
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| Format: | Article |
| Language: | English |
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AOSIS
2022-04-01
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| Series: | South African Journal of Radiology |
| Subjects: | |
| Online Access: | https://sajr.org.za/index.php/sajr/article/view/2289 |
| _version_ | 1818200575884394496 |
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| author | Jacques du Plessis Sharadini K. Gounden Carolyn Lewis |
| author_facet | Jacques du Plessis Sharadini K. Gounden Carolyn Lewis |
| author_sort | Jacques du Plessis |
| collection | DOAJ |
| description | Background: Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) aids clinicians in their decision-making processes whilst deciding whether a patient at very low risk of a clinically important TBI (ciTBI) requires a CT scan.
Objectives: To establish whether the introduction of the PECARN CDR would affect CT utilisation rates for paediatric patients presenting with minor blunt head injuries to an academic hospital in Gauteng, South Africa.
Method: This was an audit of paediatric patients who presented with minor blunt head injuries and were referred for CT imaging at an academic hospital in Gauteng, compared with PECARN CDR recommendations, over a 1-year period.
Results: A total of 100 patients were referred for CT imaging. Twenty patients were classified as very low risk, none of whom had any CT findings of a TBI or ciTBI (p 0.01). A total of 61 patients were classified as intermediate risk and 19 as high risk. In all, 23% of the intermediate and 47% of the high-risk patients had CT features of a TBI, whilst 8% and 37% had a ciTBI, respectively.
Conclusion: Computed tomography brain imaging may be omitted in patients classified as very low risk without missing a clinically important TBI. Implementing the PECARN CDR in appropriate patients would reduce CT utilisation rates. |
| first_indexed | 2024-12-12T02:39:51Z |
| format | Article |
| id | doaj.art-55f6a09eb48b4e54a9cae4b4679f420c |
| institution | Directory Open Access Journal |
| issn | 1027-202X 2078-6778 |
| language | English |
| last_indexed | 2024-12-12T02:39:51Z |
| publishDate | 2022-04-01 |
| publisher | AOSIS |
| record_format | Article |
| series | South African Journal of Radiology |
| spelling | doaj.art-55f6a09eb48b4e54a9cae4b4679f420c2022-12-22T00:41:11ZengAOSISSouth African Journal of Radiology1027-202X2078-67782022-04-01261e1e710.4102/sajr.v26i1.22891184Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An auditJacques du Plessis0Sharadini K. Gounden1Carolyn Lewis2Department of Diagnostic Radiology, School of Clinical Medicine, University of the Witwatersrand, JohannesburgDepartment of Diagnostic Radiology, School of Clinical Medicine, University of the Witwatersrand, JohannesburgDepartment of Emergency Medicine, School of Clinical Medicine, University of the Witwatersrand, JohannesburgBackground: Traumatic brain injury (TBI) is a common cause of paediatric morbidity and mortality, with higher TBI rates in low- and middle-income countries. Non-contrast brain CT is the gold standard for diagnosing intracranial injuries; however, it exposes patients to ionising radiation. The Paediatric Emergency Care Applied Research Network (PECARN) clinical decision rule (CDR) aids clinicians in their decision-making processes whilst deciding whether a patient at very low risk of a clinically important TBI (ciTBI) requires a CT scan. Objectives: To establish whether the introduction of the PECARN CDR would affect CT utilisation rates for paediatric patients presenting with minor blunt head injuries to an academic hospital in Gauteng, South Africa. Method: This was an audit of paediatric patients who presented with minor blunt head injuries and were referred for CT imaging at an academic hospital in Gauteng, compared with PECARN CDR recommendations, over a 1-year period. Results: A total of 100 patients were referred for CT imaging. Twenty patients were classified as very low risk, none of whom had any CT findings of a TBI or ciTBI (p 0.01). A total of 61 patients were classified as intermediate risk and 19 as high risk. In all, 23% of the intermediate and 47% of the high-risk patients had CT features of a TBI, whilst 8% and 37% had a ciTBI, respectively. Conclusion: Computed tomography brain imaging may be omitted in patients classified as very low risk without missing a clinically important TBI. Implementing the PECARN CDR in appropriate patients would reduce CT utilisation rates.https://sajr.org.za/index.php/sajr/article/view/2289paediatric traumacomputed tomography (ct)minor head injuriespecarntraumatic brain injurydiagnostic reference levelslow- and middle-income countriesionising radiation |
| spellingShingle | Jacques du Plessis Sharadini K. Gounden Carolyn Lewis Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit South African Journal of Radiology paediatric trauma computed tomography (ct) minor head injuries pecarn traumatic brain injury diagnostic reference levels low- and middle-income countries ionising radiation |
| title | Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit |
| title_full | Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit |
| title_fullStr | Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit |
| title_full_unstemmed | Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit |
| title_short | Paediatric minor head injury applied to Paediatric Emergency Care Applied Research Network CT recommendations: An audit |
| title_sort | paediatric minor head injury applied to paediatric emergency care applied research network ct recommendations an audit |
| topic | paediatric trauma computed tomography (ct) minor head injuries pecarn traumatic brain injury diagnostic reference levels low- and middle-income countries ionising radiation |
| url | https://sajr.org.za/index.php/sajr/article/view/2289 |
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