Adherence To Pecarn Criteria In Patients Transferred To A Pediatric Trauma Center: An Opportunity For Improvement?
Christopher Pennell1, L. Grier Arthur1, Tyler Wilson2, Adam Dykie2, Madeleine Bruce2, Sean Ciullo1
1St. Christopher's Hospital for Children, Philadelphia, PA;2Drexel University College of Medicine, Philadelphia, PA
Background (issue): PECARN has established criteria for performing CT scans of the head (CTH) that identify patients at low risk of clinically important TBI (ciTBI) in whom imaging is unnecessary. We assessed adherence to PECARN criteria from outside hospitals (OSH) for children transferred to our pediatric trauma center.
Methods: Patients <18 years old transferred between May 2016 and December 2018 undergoing CTH at an OSH were reviewed. Demographics, PECARN criteria, and imaging results were extracted from the OSH documentation. A ciTBI was defined as one causing death, requiring surgical intervention, intubation >24 hours, or hospitalization ≥2 nights with radiographic evidence of TBI (rTBI).
Findings: 202 patients were transferred after CTH. 53 were excluded for incomplete records (16), suspected abuse (33) which uses a different protocol for CT imaging, or penetrating injury (4). Of 149 included patients, PECARN recommended CTH in only 26.2% of cases. Shared decision making in 53.0%, and no imaging in 20.8%. rTBI was found in 17.4% of children, while only 4.0% had ciTBIs. Of the 6 children with ciTBIs, PECARN recommended CT in 4 and shared decision making in 2. No child in whom CTH was not recommended had a ciTBI. Two (1.3%) children underwent non-emergent surgery for ciTBI.
Conclusions (implications for practice): Adherence to PECARN criteria was low among referring facilities with up to 73.8% of CTHs being potentially avoidable with proper adherence to PECARN and parental counseling. Deferring imaging at OSHs appears safe as no child underwent emergent intervention upon arrival and may reduce the number of CTHs performed.
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