Objective: This study aimed to evaluate the diagnostic performance of the pediatric emergency care applied research network (PECARN) head computed tomography (CT) rule in a pediatric emergency department in a large trauma center in Riyadh, Saudi Arabia.
Methodology: This retrospective qualitative cross-sectional study reviewed the records of pediatric patients with minor head injuries (MHIs) who presented to the emergency department at King Abdullah Specialized Children’s Hospital. Patients who underwent head CT scans were included, with minor head injury defined by a Glasgow coma scale score of 14-15. The study population was divided into two age groups: below 2 years and 2 years and above. The PECARN criteria were retrospectively applied to determine the justification for head CTs. Data on demographic, clinical, and radiological profiles were collected.
Results: A total of 1,132 pediatric patients were included, with 372 under 2 years of age and 760 aged 2 years and above. Overall, 38.8% of the patients had positive CT findings, while 60.2% had negative findings. According to the PECARN criteria, 4.9% of the cases met the criteria for head CT. The PECARN rule demonstrated a sensitivity of 9.2%, a specificity of 97.9%, a positive predictive value (PPV) of 74.5%, and a negative predictive value of 62.2%.
Conclusion: The PECARN head CT rule showed high specificity and PPV, supporting its effectiveness in identifying pediatric patients with MHIs who do not require CT scans, thus minimizing unnecessary radiation exposure. However, the significant proportion of unjustified CTs highlighted the need for better adherence to the PECARN criteria in clinical practice. Enhancing physician education and improving clinical documentation might optimize the use of the PECARN rule and improve patient care in pediatric emergency settings.
Key words: Accuracy, PECARN, head CT, guidelines, Saudi Arabia
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