Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments
Introduction: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. O...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | Spanish |
| Published: |
Elsevier
2023-02-01
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| Series: | Anales de Pediatría (English Edition) |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2341287923000182 |
| _version_ | 1797903380870332416 |
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| author | José Antonio Alonso-Cadenas Rosa María Calderón Checa Clara Ferrero García-Loygorri Isabel Durán Hidalgo María José Pérez García Pablo Delgado Gómez Raquel Jiménez García |
| author_facet | José Antonio Alonso-Cadenas Rosa María Calderón Checa Clara Ferrero García-Loygorri Isabel Durán Hidalgo María José Pérez García Pablo Delgado Gómez Raquel Jiménez García |
| author_sort | José Antonio Alonso-Cadenas |
| collection | DOAJ |
| description | Introduction: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. Objectives: To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments (PEDs) and the adherence of each hospital to the recommendations of the PECARN rule. Population and methods: We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. Results: Of 21 981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%–40.0%), skull X-rays in 162 (44.3 %; range, 0%–100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%–24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%–100%); 37.1% (36/97) classified as intermediate-risk (range, 0%–100%) and 57.4% (132/230) classified as low-risk (range, 0%–100%). Conclusion: We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays. Resumen: Introducción: En la valoración de los lactantes menores de 3 meses con un traumatismo craneoencefálico (TCE) leve es imprescindible adecuar la indicación de pruebas radiológicas. La regla de predicción clínica (RPC) PECARN es la más utilizada para ayudar en la toma de decisiones clínicas. Objetivos: Evaluar la variabilidad en la realización de pruebas radiológicas en los menores de 3 meses con un TCE leve en los servicios de urgencias pediátricos (SUP) y la adherencia de cada hospital a las recomendaciones de la RPC PECARN. Población y métodos: Estudio de cohortes prospectivo en <3 meses con un TCE leve que consultaron en 13 SUP españoles entre mayo de 2017 y noviembre de 2020. Resultados: Se atendieron 21.981 pacientes con un TCE leve, de los que 366 (1,7%) eran menores de 3 meses. Se realizaron pruebas de imagen al 53,3% (195): TC craneal a 37 [10,1% (rango entre hospitales 0%-40,0%)], radiografía de cráneo a 162 [44,3% (rango 0%-100%)] y ecografía transfontanelar a 22 [6,0% (rango 0%-24,0%)]. Se siguieron las recomendaciones PECARN en el 25,6% (10/39) de los lactantes con criterios de alto riesgo (rango 0%-100%); el 37,1% (36/97) de los de riesgo intermedio (rango 0%-100%) y el 57,4% (132/230) de los de bajo riesgo (rango 0%-100%). Conclusiones: Existe gran variabilidad, con un bajo cumplimiento de las recomendaciones PECARN, en la realización de pruebas radiológicas en los menores de 3 meses que consultan por un TCE leve en los SUP españoles, a expensas fundamentalmente de un exceso en el empleo de radiografías de cráneo. |
| first_indexed | 2024-04-10T09:32:00Z |
| format | Article |
| id | doaj.art-6cd84aef3b2c4bb29e954b3b558e840e |
| institution | Directory Open Access Journal |
| issn | 2341-2879 |
| language | Spanish |
| last_indexed | 2024-04-10T09:32:00Z |
| publishDate | 2023-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Anales de Pediatría (English Edition) |
| spelling | doaj.art-6cd84aef3b2c4bb29e954b3b558e840e2023-02-19T04:25:59ZspaElsevierAnales de Pediatría (English Edition)2341-28792023-02-019828391Variability in the management of infants under 3 months with minor head injury in paediatric emergency departmentsJosé Antonio Alonso-Cadenas0Rosa María Calderón Checa1Clara Ferrero García-Loygorri2Isabel Durán Hidalgo3María José Pérez García4Pablo Delgado Gómez5Raquel Jiménez García6Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain; Corresponding author.Servicio de Urgencias, Hospital Universitario Materno-Infantil Doce de octubre, Madrid, SpainServicio de Urgencias, Hospital Universitario Materno-Infantil Gregorio Marañón, Madrid, SpainServicio de Urgencias, Hospital Universitario Materno-Infantil Málaga, Málaga, SpainServicio de Pediatría, Hospital Universitario Puerta De Hierro, Majadahonda, Madrid, SpainServicio de Urgencias, Hospital Universitario Materno-Infantil Virgen del Rocío, Sevilla, SpainServicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, SpainIntroduction: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. Objectives: To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments (PEDs) and the adherence of each hospital to the recommendations of the PECARN rule. Population and methods: We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. Results: Of 21 981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%–40.0%), skull X-rays in 162 (44.3 %; range, 0%–100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%–24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%–100%); 37.1% (36/97) classified as intermediate-risk (range, 0%–100%) and 57.4% (132/230) classified as low-risk (range, 0%–100%). Conclusion: We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays. Resumen: Introducción: En la valoración de los lactantes menores de 3 meses con un traumatismo craneoencefálico (TCE) leve es imprescindible adecuar la indicación de pruebas radiológicas. La regla de predicción clínica (RPC) PECARN es la más utilizada para ayudar en la toma de decisiones clínicas. Objetivos: Evaluar la variabilidad en la realización de pruebas radiológicas en los menores de 3 meses con un TCE leve en los servicios de urgencias pediátricos (SUP) y la adherencia de cada hospital a las recomendaciones de la RPC PECARN. Población y métodos: Estudio de cohortes prospectivo en <3 meses con un TCE leve que consultaron en 13 SUP españoles entre mayo de 2017 y noviembre de 2020. Resultados: Se atendieron 21.981 pacientes con un TCE leve, de los que 366 (1,7%) eran menores de 3 meses. Se realizaron pruebas de imagen al 53,3% (195): TC craneal a 37 [10,1% (rango entre hospitales 0%-40,0%)], radiografía de cráneo a 162 [44,3% (rango 0%-100%)] y ecografía transfontanelar a 22 [6,0% (rango 0%-24,0%)]. Se siguieron las recomendaciones PECARN en el 25,6% (10/39) de los lactantes con criterios de alto riesgo (rango 0%-100%); el 37,1% (36/97) de los de riesgo intermedio (rango 0%-100%) y el 57,4% (132/230) de los de bajo riesgo (rango 0%-100%). Conclusiones: Existe gran variabilidad, con un bajo cumplimiento de las recomendaciones PECARN, en la realización de pruebas radiológicas en los menores de 3 meses que consultan por un TCE leve en los SUP españoles, a expensas fundamentalmente de un exceso en el empleo de radiografías de cráneo.http://www.sciencedirect.com/science/article/pii/S2341287923000182Servicios de urgenciasTraumatismo craneal leveLactante |
| spellingShingle | José Antonio Alonso-Cadenas Rosa María Calderón Checa Clara Ferrero García-Loygorri Isabel Durán Hidalgo María José Pérez García Pablo Delgado Gómez Raquel Jiménez García Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments Anales de Pediatría (English Edition) Servicios de urgencias Traumatismo craneal leve Lactante |
| title | Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments |
| title_full | Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments |
| title_fullStr | Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments |
| title_full_unstemmed | Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments |
| title_short | Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments |
| title_sort | variability in the management of infants under 3 months with minor head injury in paediatric emergency departments |
| topic | Servicios de urgencias Traumatismo craneal leve Lactante |
| url | http://www.sciencedirect.com/science/article/pii/S2341287923000182 |
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