33 - Assessment of the impact and compliance with PECARN criteria on head CT scanning rates

Poster Number: 33
Publication Number: 33.406

Afreen Abraham, Southern Illinois University School of Medicine, Springfield, IL, United States; Matt Turner, Southern Illinois University School of Medicine, Springfield, IL, United States; Kristin Delfino, SIU School of Medicine, Springfield, IL, United States; Sharon Kim, Southern Illinois University School of Medicine, Springfield, IL, United States; Danuta Dynda, Southern Illinois University School of Medicine, Springfield, IL, United States; Myto Duong, Southern Illinois University School of Medicine, Springfield, IL, United States

Background: Evaluation for traumatic brain injury (TBI) in children varies significantly between providers. Management of this population has long been difficult for emergency medicine physicians attempting to balance the need for head computed tomography (CT) imaging with the associated cost and radiation exposure risks to the patients. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) provided guidelines for identifying children who are at very low risk of clinically important traumatic brain injury (ciTBI) after minor head trauma, who would not require imaging. We hypothesized that, with the creation of PECARN guidelines, CT scanning rates at our institution would be more unified.

Objective: The purpose of this study was to determine the impact of PECARN guidelines on physician and mid-level provider compliance with these recommendations in our emergency departments and to identify areas for quality improvement in the management of pediatric head trauma.

Design/Methods: This retrospective chart review study included over 3000 pediatric patients aged < 18 years with diagnoses indicative of head injury who presented to our local emergency department between 2017 and 2019. Patients were stratified according to age ( < 2 years old or >2 years old) and risk of ciTBI based on PECARN criteria (High, Intermediate or Low risk). PECARN ciTBI definition was used and was defined as head injury resulting in death, requiring neurosurgical intervention, intubation for >24 hours, or hospital admission of 2 or more nights due to TBI. Descriptive statistics were computed for all study variables.

Results: Of the 595 patient charts reviewed out of a total of 3529 charts, 93 were < 2 years old and 502 were >2 years old. A total of 37 (6%) patients were categorized as high risk, 117 (20%) as intermediate risk, and 441 (74%) as low risk of having ciTBI based on the PECARN guidelines. Out of 37 patients deemed high risk, 29 (78.4%) obtained a head CT. In the 117 patients with intermediate risk, 53 (45.3%) had a head CT. In 441 patients with low risk, 42 (9.5%) had a head CT.Conclusion(s): Overall, we see a decrease in head CTs ordered by providers as the risk of ciTBI decreases. Providers were less likely to order head CT based on risk stratification when PECARN criteria was considered and noted in the chart. The majority of the patients seen in the ED for head injury, have low risk of ciTBI, and more work is needed to reduce the head CT scanning rate in these patients. Further quality improvement initiatives are needed to improve physician compliance with PECARN guidelines in the management of pediatric head trauma in our community emergency departments.
CV- Afreen Abraham.pdf