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New guidelines help predict brain injury in children

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New predictive guidelines aim to help prevent the unnecessary use of CT scans for diagnosing traumatic brain injury in children. 

Head and abdominal trauma is a leading cause of death for children, with around one to two per cent of children who visit emergency departments with head or abdominal injuries requiring immediate intervention. 

These injuries are commonly diagnosed by computed tomography (CT) scans. But CT-related radiation can cause cancers later in life, and accumulated evidence suggests that CT is overused.

To help medical teams avoid unnecessary CT scans, the Pediatric Emergency Care Applied Research Network (PECARN), a federally funded network of institutions performing paediatric emergency medicine research, previously developed a set of predictive guidelines. 

Prediction v reality

To validate the PECARN prediction rules, CHLA researchers collaborated on a prospective, multicentre study, funded by the National Institutes of Health, enrolling thousands of children who came to the CHLA Emergency Department over a five-year period.

Nationwide, the study enrolled 7,542 children and adolescents under 18 years old who received CT scans at six paediatric emergency departments for blunt abdominal trauma, as well as almost 20,000 children with minor head trauma. These were divided into two age groups, those younger than 2 years, and 2 years and older. 

The primary outcome for the abdominal trauma group was intra-abdominal injury needing acute intervention, and for the head trauma cohort, clinically important traumatic brain injury. 

The children were evaluated against the variables of the relevant PECARN prediction rule before actual CT results were seen. 

The researchers found that the intra-abdominal injury rule had a sensitivity of 100 per cent and could predict at 100 per cent accuracy if a child did not need a CT scan.  

Additionally, the traumatic brain injury rule for children younger than 2 years had a sensitivity of 100 per cent for clinically important traumatic brain injuries and could predict with 100 per cent accuracy if a child did not need a CT scan; for children ages 2 and older, a sensitivity of 98.8 per cent and prediction at 100.0 per cent accuracy if CT scan was unnecessary.   

“There is an urgent need for validated guidelines for the safe use of CT to diagnose injured children while preventing unnecessary radiation exposure,” says Pradip Chaudhari, MD, study co-author and director of Research and Scholarship, Division of Emergency and Transport Medicine, at Children’s Hospital Los Angeles.

“We found both the PECARN intra-abdominal injury and traumatic brain injury prediction rules were safe and effective with a high degree of accuracy. 

“Using these guidelines will help emergency departments to safely minimise unnecessary CT scans in children.”  

The researchers’ findings were published in The Lancet Child & Adolescent Health.

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