Resumen:
Introducción: El uso excesivo de tomografía computarizada (TC) en niños con trauma craneal leve puede evitarse aplicando la regla de la Red de Investigación Aplicada en Cuidados de Emergencia Pediátrica (PECARN). Los objetivos de este estudio fueron (1) aplicar la regla PECARN para predecir lesiones cerebrales traumáticas en TC de cabeza en pacientes pediátricos mexicanos con trauma craneal leve y (2) evaluar la extensión del uso excesivo de TC de cabeza en casos que no cumplían con los criterios de la regla PECARN. Materiales y métodos: Realizamos un estudio transversal de niños de 0 a 10 años con trauma craneal leve (Escala de Coma de Glasgow de 14-15 puntos) en el que se ordenó una TC de cabeza por parte de los clínicos de referencia en el departamento de emergencias. La regla PECARN se aplicó de forma retrospectiva. Resultados: Se incluyeron un total de 145 niños con trauma craneal leve: 64 (44.8%) niñas y 80 (55.2%) niños. Las edades medias fueron de 3.7 ± 2.5 y 2.7 ± 2.2 años, respectivamente. La regla PECARN no se cumplió en 29 (20.0%) de los 145 niños; por lo tanto, se debería haber omitido una TC de cabeza. La regla PECARN tuvo una sensibilidad del 97.5% (intervalo de confianza [IC] del 95% 92.6-100) y un valor predictivo negativo del 96.5% (IC del 95% 60.7-100) para predecir lesiones cerebrales traumáticas clínicamente importantes en TC en pacientes pediátricos con trauma craneal leve. Conclusión: Este es el primer estudio en México que muestra que hay un uso excesivo de TC de cabeza en pacientes pediátricos con trauma craneal leve. Este hallazgo puede deberse a que los clínicos del departamento de emergencias pasan por alto la regla PECARN.

Abstract:
Introduction: Computed tomography (CT) overuse in children with mild head trauma can be avoided by applying the Pediatric Emergency Care Applied Research Network (PECARN) rule. The aims of this study were (1) to apply the PECARN rule to predict traumatic brain injury on head CT in Mexican pediatric patients with mild head trauma and (2) to evaluate the extent of head CT overuse in cases that did not meet the criteria of the PECARN rule. Materials and methods: We conducted a cross-sectional study of children aged 0-10 years with mild head trauma (Glasgow Coma Scale 14-15 points) in which a head CT was ordered by referring clinicians in the emergency department. The PECARN rule was applied retrospectively. Results: A total of 145 children with mild head trauma were included: 64 (44.8%) girls and 80 (55.2%) boys. The mean ages were 3.7 ± 2.5 and 2.7 ± 2.2 years, respectively. The PECARN rule was not fulfilled in 29 (20.0%) of 145 children; therefore, a head CT should have been omitted. The PECARN rule had a sensitivity of 97.5% (95% confidence interval [CI] 92.6-100) and a negative predictive value of 96.5% (95% CI 60.7-100) for predicting clinically important traumatic brain injury on CT in pediatric patients with mild head trauma. Conclusion: This is the first study in Mexico which shows that there is head CT overuse in pediatric patients with mild head trauma. This finding may be due to emergency department clinicians overlooking the PECARN rule.

Abstract:
Introduction: Computed tomography (CT) overuse in children with mild head trauma can be avoided by applying the Pediatric Emergency Care Applied Research Network (PECARN) rule. The aims of this study were (1) to apply the PECARN rule to predict traumatic brain injury on head CT in Mexican pediatric patients with mild head trauma and (2) to evaluate the extent of head CT overuse in cases that did not meet the criteria of the PECARN rule. Materials and methods: We conducted a cross-sectional study of children aged 0-10 years with mild head trauma (Glasgow Coma Scale 14-15 points) in which a head CT was ordered by referring clinicians in the emergency department. The PECARN rule was applied retrospectively. Results: A total of 145 children with mild head trauma were included: 64 (44.8%) girls and 80 (55.2%) boys. The mean ages were 3.7 ± 2.5 and 2.7 ± 2.2 years, respectively. The PECARN rule was not fulfilled in 29 (20.0%) of 145 children; therefore, a head CT should have been omitted. The PECARN rule had a sensitivity of 97.5% (95% confidence interval [CI] 92.6-100) and a negative predictive value of 96.5% (95% CI 60.7-100) for predicting clinically important traumatic brain injury on CT in pediatric patients with mild head trauma. Conclusion: This is the first study in Mexico which shows that there is head CT overuse in pediatric patients with mild head trauma. This finding may be due to emergency department clinicians overlooking the PECARN rule.