Thursday, October 15, 2009

Prediction Rule Identifies Low Risk Children after Minor Head Trauma

This email came to me from Dynamed which is an evidence-based medicine resource which gives good information about avoiding unnecessary radiation in a child with a bump on the head.
At Health Quest Family Medicine we try to take the conservative approach when treating children and adults.

Computed tomography (CT) is often performed on children with head trauma to diagnose clinically important traumatic brain injuries. Attempts have been made to develop criteria that might safely avoid unnecessary procedures. The Pediatric Emergency Care Applied Research Network study (PECARN) has now developed a prediction rule that identifies children at very low risk of clinically important injury for whom CT imaging may be avoided (level 1 [likely reliable] evidence). The derivation and validation cohorts included 42,412 children 2 years old meeting all of the following criteria: normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, and no severe headache. CT can be withheld in children hematoma except frontal, loss of consciousness 0-5 seconds, non-severe injury mechanism, no palpable skull fracture, and acting normally according to the parents. The rule had sensitivity of 97%-100%, specificity of 54%-60%, and negative predictive value of 99%-100% (Lancet 2009 Oct 3;374(9696):1160).

For more information, see the Decision rules for computed tomography in head injury in children topic in DynaMed.