Validity of Pediatric Emergency Care Applied Research Network (PECARN) in Pediatric Trauma Patients - A Cross Sectional Study from a Tertiary Care Hospital in Pakistan

Abstract

Introduction: Head trauma in the pediatric age group is a common presentation in the Emergency Room (ER). The Pediatric Emergency Care Applied Research Network (PECARN) tool can help an ER clinician to identify pediatric head trauma patients at very low risk of clinically important traumatic brain injuries (ciTBIs) and avoid unnecessary CT scans. Objective: To determine the validity of PECARN rule as compared to the head CT (gold standard) in identifying low risk traumatic brain injury pediatric patients. Methods: A cross-sectional study was done at Aga Khan University Hospital (AKUH) Emergency Department ED. All pediatric head trauma patients were included in this study between 2017-2019. A total of 218 head trauma cases were reviewed which were evaluated for the PECARN criteria. Data were extracted on a prepared data collection form. Data were entered and analyzed using SPSS. Chi-square test was used. Results: Among the total 218, 190 cases (87%) had CT scans ordered. Out of these 190 patients 156 (82%) met PECARN criteria, while 34 (18%) were PECARN negative. The sensitivity and specificity of PECARN was calculated as 82% and 33% respectively, with a fair level of agreement with CT scan based on Kappa statistics. Conclusion: PECARN has a higher sensitivity but lower specificity in comparison to CT scan.