![]() ![]() The younger age group includes infants aged less than 3 months, a particularly vulnerable group to which the same recommendations used in all other age groups currently apply, despite a lack of studies on the particular characteristics of this paediatric subset 5,6. The PECARN rule differentiates between children aged 2 years or more and younger children 2. It is well known that there is substantial variation in the use of CT of the head in children with minor HI in paediatric emergency departments (PEDs) 2,3.Ĭlinical prediction rules (CPRs) have been developed with the aim of reducing variability in the ordering of head CT for assessment of paediatric minor HI, such as the Pediatric Emergency Care Applied Research Network (PECARN) 4 rule, which is the most widely used. Computed tomography (CT) of the head is the gold for detection of an ICL, but the decision whether to use this imaging technique must weigh the importance of identifying an ICL that, while unlikely, could lead to important complications, against the risks involved in performing the test, the exposure to radiation and/or the need of sedation. The greatest challenge in the assessment of patients with minor head injury (HI) (defined as a Glasgow Coma Scale score of 14–15) is differentiating patients at risk of intracranial lesions (ICLs) from those at low risk and avoiding unnecessary diagnostic procedures. Clinical variations unrelated to the course of disease are unwarranted. Variability of care is defined as the systematic presence of variations in the use of a medical or surgical procedure or its outcomes, once the possibility that these differences can be attributed to the patients is ruled out 1. ConclusionesĮxiste gran variabilidad, con un bajo cumplimiento de las recomendaciones PECARN, en la realización de pruebas radiológicas en los menores de 3 meses que consultan por un TCE leve en los SUP españoles, a expensas fundamentalmente de un exceso en el empleo de radiografías de cráneo. Se siguieron las recomendaciones PECARN en el 25,6% (10/39) de los lactantes con criterios de alto riesgo (rango 0%-100%) el 37,1% (36/97) de los de riesgo intermedio (rango 0%-100%) y el 57,4% (132/230) de los de bajo riesgo (rango 0%-100%). Se realizaron pruebas de imagen al 53,3% (195): TC craneal a 37, radiografía de cráneo a 162 y ecografía transfontanelar a 22. Se atendieron 21.981 pacientes con un TCE leve, de los que 366 (1,7%) eran menores de 3 meses. Población y métodosĮstudio de cohortes prospectivo en <3 meses con un TCE leve que consultaron en 13 SUP españoles entre mayo de 2017 y noviembre de 2020. ![]() ![]() ObjetivosĮvaluar la variabilidad en la realización de pruebas radiológicas en los menores de 3 meses con un TCE leve en los servicios de urgencias pediátricos (SUP) y la adherencia de cada hospital a las recomendaciones de la RPC PECARN. La regla de predicción clínica (RPC) PECARN es la más utilizada para ayudar en la toma de decisiones clínicas. We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays.Įn la valoración de los lactantes menores de 3 meses con un traumatismo craneoencefálico (TCE) leve es imprescindible adecuar la indicación de pruebas radiológicas. The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%–100%) 37.1% (36/97) classified as intermediate-risk (range, 0%–100%) and 57.4% (132/230) classified as low-risk (range, 0%–100%). Of 21 981 children with MHI, 366 (1.7%) were aged less than 3 months 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1% interhospital range, 0%–40.0%), skull X-rays in 162 (44.3 % range, 0%–100%) and transfontanellar ultrasound scans in 22 (6.0% range, 0%–24.0%). We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments (PEDs) and the adherence of each hospital to the recommendations of the PECARN rule. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. ![]()
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