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Evaluation of Computed tomography (CT) scan ordering in children with mild head injury at Emergency Department at Suez Canal University Hospital

Ahmed Abouzeid, Mohamed Shaban, Tarek Emam, Nehal Shokry.

CT is the gold standard diagnostic test for evaluating children with head trauma however, this procedure has disadvantages, including exposure to ionizing radiation, transport of the child away from the direct supervision of emergency physicians, the frequent requirement for pharmacologic sedation, additional health care costs, and increased time for completing Emergency Department (ED) evaluation. The Pediatric Emergency Care Applied Research Network (PECARN) is a clinical decision rule that aims to determine which children are at very low risk of developing clinically important traumatic brain injury (ci TBI) * and who therefore do not require a CT scan of the head.
*(ci TBI) defined by death from TBI, need for Neurosurgery, intubation more than 24 hours for TBI, or Hospital admission more than 2 nights for TBI.
Aim of the study: The aim of this study was to improve the quality of management of children with mild Traumatic Brain Injury (mTBI) at the Emergency Department (ED) by evaluating CT scan ordering in comparison to the PECARN clinical decision rule (CDR).
Methodology: The present study was a cross sectional observational study that was conducted at the Emergency Department (ED) of Suez Canal University (SCU) Hospital. It included 97 children 18 years old or younger with history of blunt head trauma within the last 24 hours with Glasgow coma score (GCS) between 13-15 who presented to ED of SCU Hospital.

The present study revealed that 20.6% of patients were classified as High Risk, 45.3% as Intermediate Risk, and 35% as Low risk of developing (ci TBI) according to PECARN CDR. CT scan was ordered
in all patients classified as High Risk, 90.9% of patients classified as Intermediate Risk, and 51.5% of patients classified as Low Risk.
This study also revealed that falling from height (FFH) was the most common cause of mTBI (60% of patients) and direct head injury was the second common cause (30% of patients).
Conclusion: The present study revealed that most of the patients were adherent to PECARN CDR. In addition, most of the patients younger than 2 years old followed the CDR. Most of the patients older than 2 years old followed the CDR.

Key words: PECARN, CDR

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American Journal of Research in Medical Sciences


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