Minör Kafa Travması Olan Çocuklara Yaklaşımda Pecarn (Pedıatrıc Emergency Care Applıed Research Network) ve Nıce (Natıonal Instıtute For Health and Care Excellence) Kafa Travması Rehberlerinin Karşılaştırılması

Abstract

The Comparison of PECARN (Pediatric Emergency Care Applied Research Network) and NICE (National Institute for Health and Care Excellence) Head Trauma Guidelines in Management of Children with Minor Head Trauma. Hacettepe University, Faculty of Medicine, A thesis on Pediatrics. Ankara 2017.

Introduction: Head trauma in children is among the most common reasons of pediatric emergency department admissions. The majority of patients with minor head trauma havemild symptoms and very few of them require surgical interventions. However, managementof head traumas might be complicated and challengingfor the physicians working in emergency services. Thus, it is vitally important for emergency physicians to establish an early diagnosis of the head trauma, manage it accurately and minimize morbidity, mortality and radiation exposure. Recently, several guidelines have been createdto overcome this difficulty and to guide the physicians in giving their clinical decisionseasily. Aim: The primary aim is to evaluate patients admitted to the Pediatric Emergency Department with minor head traumas by using NICE (National Institute for Health and Care Excellence) and PECARN (PaediatricEmergency Care Applied Research Network) head trauma guidelinesand to determine the specificity and sensitivity of the findings of abnormal brain computed tomography (CT), traumatic brain injury (TBI) and to indicate clinically important TBI (ciTBI). Method: Patients aging from 0 to 18 years admitted to the Pediatric Emergency Departmentwith minor head trauma within the first 24 hours of the incidentbetween June 1, 2015 and May 21, 2016 were included and patient’s files were evaluated retrospectively.Patients who had a CT scan were identified.CT indications, CT findings, TBI and the frequency of ciTBI were recorded. All patients wereevaluated in accordance with the PECARN and NICE guidelines. Findings: 1539 patients (M/F 1/1.8) with minor head trauma were included in the study. Median age of the patients included were 4 years old. The most common head trauma mechanism was falls(p<0.001). While the most commonly seen complaint was loss of consciousness (2.5%) and the most frequent physical examination finding was laceration (30%). 10% of the patients had a brain CT scan and in 15% out of these patients abnormal CT findings were detected. 11% of the patients who underwent brain CT had TBI and 10.4% were determined to have ciTBI. Among the study population, the ratio of TBI was 1.1% and ciTBI was 1%. According to the NICE guideline, CT scan was indicated in 2.5% of patients while1.6% according to the PECARN guideline. The sensitivity of NICE head trauma guideline was 82.4%; and specificity was 66.7% (PPD: 87,5%, NPD: 57,1%) whereas the sensitivity of PECARN head trauma guideline was 76.5% and the specificity 100% (PPD: 100%, NPD: 60%) for identifying TBI. Conclusion: Brain CT imaging rate was found to be higher in our study population when compared with NICE and PECARN head trauma guidelines. Even if the frequency of CT was reduced with the suggestion of both guidelines, sensitivity and specificity of these guidelines were found to be low in this study. However, though PECARN guideline seems to be beneficial in patients with minor head trauma, it needs to be supported by prospective studies. Key Terms: Minor head trauma, traumatic brain injury, clinically important traumatic brain injury, Brain computerized tomography, NICE, PECARN