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Missed intracranial injuries are rare in emergency departments using the PECARN head injury decision rules

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Abstract

Purpose

The PECARN head trauma (HT) prediction rules have been developed to guide computed tomography–related decision-making for children with minor HT (mHT). There are currently limited data on the rate of unscheduled revisits to emergency departments (EDs), and initially missed intracranial injuries, in children with mHT initially assessed using the PECARN rules. This study aimed to fill this gap in knowledge.

Methods

Clinical charts of children assessed for mHT over a 5-year period at two EDs that implemented the PECARN rules in Italy and France were reviewed retrospectively. Children who returned to EDs for mHT-related, or potentially related complaints, within 1 month of initial assessment were included.

Results

The total number of children with mHT presenting for the first time to the EDs of both sites was 11,749. Overall, 180 (1.5%) unscheduled revisits to the EDs occurred for mHT-related or potentially related complaints. Twenty-three of these 180 patients underwent neuroimaging, and seven had an intracranial injury (including one ischemic stroke). Of these, three were hospitalized and none needed neurosurgery or intensive care.

Conclusion

Unscheduled revisits for mHT in EDs using the PECARN rules were very uncommon. Initially missed intracranial injuries were rare, and none needed neurosurgery or intensive care.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Dr. Elena Tombolan for her assistance with data collection.

Author information

Authors and Affiliations

  1. Division of Pediatric Emergency Medicine, Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 3, 35128, Padova, Italy

    Silvia Bressan, Paola Berlese, Marta Arpone & Liviana Da Dalt

  2. Pediatric Emergency Department, Robert Debré Hospital, Paris, France

    Paola Berlese & Luigi Titomanlio

  3. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

    Ivan Steiner

Authors
  1. Silvia Bressan
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  2. Paola Berlese
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  3. Marta Arpone
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  4. Ivan Steiner
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  5. Luigi Titomanlio
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  6. Liviana Da Dalt
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Contributions

Conceptualization: Silvia Bressan, Liviana Da Dalt; methodology: Silvia Bressan, Liviana Da Dalt, Luigi Titomanlio; formal analysis and investigation: Silvia Bressan, Marta Arpone; writing—original draft preparation: Silvia Bressan, Marta Arpone, Liviana Da Dalt; writing—review and editing: Silvia Bressan, Paola Berlese, Marta Arpone, Ivan Steiner, Luigi Titomanlio, Liviana Da Dalt; resources: not applicable; supervision: Liviana Da Da Dalt, Ivan Steiner, Luigi Titomanlio.

Corresponding author

Correspondence to Silvia Bressan.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

The study was approved by the Ethics Committee of the University Hospital of Padova and of the Robert Debré Hospital in Paris.

Consent to participate

Waiver of participants’ informed consent was approved by the study center’s Ethics Committees, this being a retrospective study.

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No identifiable data are included in our study.

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Bressan, S., Berlese, P., Arpone, M. et al. Missed intracranial injuries are rare in emergency departments using the PECARN head injury decision rules. Childs Nerv Syst 37, 55–62 (2021). https://doi.org/10.1007/s00381-020-04660-0

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  • DOI: https://doi.org/10.1007/s00381-020-04660-0

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