New report suggests fewer CT scans may be needed to provide high-quality emergency care for children study from the Department of Emergency Medicine at UC Davis Health.
Research — Published in The Lancet Child and Youth Health Journal — Validate prediction rules for intra-abdominal injury (IAI) and traumatic brain injury (TBI). Pediatric Emergency Medicine Applied Research Network (Pekan).
The IAI and TBI prediction rules were created by co-principal investigators Nathan Kupperman, chief of emergency medicine, and James Holmes, chief of emergency medicine. They aimed to reduce the inappropriate use of computed tomography (CT) in injured children.
by Centers for Disease Control and Prevention According to the (CDC), trauma is the leading cause of death among children in the United States. Among pediatric traumatic deaths, traumatic brain injury is the most common cause, with IAI accounting for 30% of cases.
CT scans are currently the standard for diagnosing IAI and TBI. However, this procedure is estimated to result in fatal ionizing radiation-induced malignancy or cancer in 1 in 500 abdominal CT scans in children under 5 years of age. For adolescents, this number is 1 in every 600 scans.
“While CT scans can be a useful diagnostic tool for diagnosing and treating patients, they also carry the risk of radiation-induced malignancies,” Kuppermann explained. “Validating these evidence-based rules will reduce unnecessary CT imaging in children with head or abdominal trauma, improving patient safety by reducing the risk of potential malignancies.” I hope we can improve this.”
Validating these evidence-based rules will reduce unnecessary CT imaging in children with head or abdominal trauma and improve patient safety by reducing the risk of potential malignancies. I’m thinking of increasing it. ”—nathan kupperman
Benefits of IAI and TBI rules
The study was conducted at six pediatric trauma centers. but, prior evidence We suggest that the PECARN IAI and TBI rules can be safely implemented in community hospitals. By leveraging the IAI and TBI regulations, community hospitals can increase emergency department preparedness to treat acutely ill and injured children.
“The care a child receives in the emergency department determines whether or not they survive,” Holmes explained. “These rules will strengthen emergency department preparedness and ensure that every child receives quality emergency care.”
Additionally, the study authors believe these results may have implications for racial and ethnic disparities in the use of medical images in emergency departments across the United States.
“Evidence shows that there are racial, ethnic, and demographic disparities in the use of medical images in emergency departments,” Kupperman said. “By providing evidence-based protocols for clinicians to follow, we can standardize care and prevent variance.”
These rules will strengthen emergency department preparedness and ensure that all children receive quality emergency care. ” —james holmes
Research methods and results
Researchers conducted a prospective cohort study at six Level 1 pediatric trauma centers. They studied cases of children under 18 years of age who had sustained blunt abdominal or mild head trauma. Enrolled children were assessed as positive or negative against previously derived PECARN prediction rules before learning their CT results.
Overall, 7,542 blunt abdominal trauma patients and 19,999 head trauma patients were enrolled in the study. The IAI rules had an accuracy rate of 100% (145/145) and a negative predictive value of 100% (3,488/3,488) for patients requiring a CT scan.
The traumatic brain injury rule for patients younger than 2 years had a 100% correct rate (42/42) and a 100% negative predictive value (2,940/2,940) for patients requiring a CT scan. For children 2 years of age and older, the traumatic brain injury rule for patients requiring CT scan was 98.8% (168/170), and the negative predictive value was 99.97% (6,015/6,017). Neither of her two children with traumatic brain injuries that were misclassified by the traumatic brain injury rules required neurosurgical or other treatment beyond hospital observation.
“With this robust validation, these clinical prediction rules should be widely disseminated and implemented in clinical practice,” Holmes said. “Wide use could further reduce unnecessary CT scans of injured children.”
Other centers participating in the study include: Eunice Kennedy Shriver National Institute of Child Health and Human Development They include Children’s Medical Center in Dallas, Utah Health Houston, and Rady Children’s Hospital in San Diego. Children’s Hospital in Los Angeles and his UCSF Benioff Children’s Hospital in Oakland.
