ACCURACY OF PECARN DECISION RULE IN MINOR BLUNT HEAD TRAUMA IN PEDIATRIC
EMERGENCY DEPARTMENT: A META-ANALYSIS
Abstract
Background: Pediatric Emergency Care Applied Research Network (PECARN)
is a useful Clinical Decision Support Tool (CDST) to identify traumatic
brain injuries and reduce the use of head CT scans among pediatric
patients. The present Meta-analysis aims to evaluate the diagnostic
accuracy of the PECARN rule from 2009 to 2020 in children with a very
low risk of blunt head trauma. Methods: A detailed search was conducted
from the databases of Medline (via PubMed), Cinahl (via Ebsco), Scopus,
Web of Sciences, from 2009 till the end of December 2020 using the
keywords like decrease use of CT scan, blunt head trauma (BHT) combined
with accuracy, Pediatric Emergency Care Applied Research Network
(PECARN) OR Clinical Decision Support Tool (CDST). Studies showing the
diagnostic accuracy of the PECARN rule in children younger than 18 years
of age with minor BHT were included. Results: 13 studies were included
in the present analysis. Pooled sensitivity of 0.08, (95% confidence
interval of 0.074 - 0.087), pooled specificity of 0.20 ( 95% CI of
0.196 - 0.213) and diagnostic odds ratio of 0.004 (95% CI of
0.000-0.1666) was in <2 years of age. The overall sensitivity
of 0.07, specificity of 0.66, and diagnostic odds ratio of 0.54 (95% CI
of 0.10 -2.78) was seen in ≥2 years of age. Overall sensitivity of 0.13
(95% CI 0.12-0.14), specificity of 0.81 (95% CI 0.80-0.82) and
diagnostic odds ratio of 0.79 (95% CI of 0.08 -7.71) was in 0-18 years
of age. Conclusion: The present analysis indicates the PECARN decision
tool as an accurate CDST in low-risk minor blunt head trauma cases in
children below two years of age and can become a useful tool in reducing
Head CT’s scan overuse in pediatric emergency departments.