Implementation of Adapted PECARN Decision Rule for Children With Minor Head Injury in the Pediatric Emergency Department

• Published in: Academic emergency medicine 2012-07, Vol.19 (7), p.801-807
• Main Authors: Bressan, Silvia, Romanato, Sabrina, Mion, Teresa, Zanconato, Stefania, Da Dalt, Liviana
• Format: Article
• Language: English
• Subjects: Algorithms; Attitude of Health Personnel; Brain Injuries - diagnosis; Brain Injuries - diagnostic imaging; Child, Preschool; Childrens health; Craniocerebral Trauma - complications; Craniocerebral Trauma - diagnostic imaging; Craniocerebral Trauma - therapy; Decision Making; Decision Support Techniques; Decision theory; Emergency medical care; Emergency Service, Hospital; Emergency Treatment - methods; Female; Guideline Adherence; Head injuries; Humans; Infant; Italy; Male; Medical personnel; Pediatrics; Practice Guidelines as Topic; Tomography, X-Ray Computed
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1111/j.1553-2712.2012.01384.x

ACADEMIC EMERGENCY MEDICINE 2012; 19:801–807 © 2012 by the Society for Academic Emergency Medicine Objectives:  Of the currently published clinical decision rules for the management of minor head injury (MHI) in children, the Pediatric Emergency Care Applied Research Network (PECARN) rule, derived and validated in a large multicenter prospective study cohort, with high methodologic standards, appears to be the best clinical decision rule to accurately identify children at very low risk of clinically important traumatic brain injuries (ciTBI) in the pediatric emergency department (PED). This study describes the implementation of an adapted version of the PECARN rule in a tertiary care academic PED in Italy and evaluates implementation success, in terms of medical staff adherence and satisfaction, as well as its effects on clinical practice. Methods:  The adapted PECARN decision rule algorithms for children (one for those younger than 2 years and one for those older than 2 years) were actively implemented in the PED of Padova, Italy, for a 6‐month testing period. Adherence and satisfaction of medical staff to the new rule were calculated. Data from 356 visits for MHI during PECARN rule implementation and those of 288 patients attending the PED for MHI in the previous 6 months were compared for changes in computed tomography (CT) scan rate, ciTBI rate (defined as death, neurosurgery, intubation for longer than 24 hours, or hospital admission at least for two nights associated with TBI) and return visits for symptoms or signs potentially related to MHI. The safety and efficacy of the adapted PECARN rule in clinical practice were also calculated. Results:  Adherence to the adapted PECARN rule was 93.5%. The percentage of medical staff satisfied with the new rule, in terms of usefulness and ease of use for rapid decision‐making, was significantly higher (96% vs. 51%, p