ArticleAnnals of emergency medicine2015
Cost-effectiveness of the PECARN rules in children with minor head trauma.
Article in Annals of emergency medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Quality of health economic evaluations in emergency medicine journals: a systematic review.CJEM · 2023Pooled it
- Italian guidelines on the assessment and management of pediatric head injury in the emergency department.Italian journal of pediatrics · 2018Pooled it
- Serum S100B Level in the Management of Pediatric Minor Head Trauma: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma: Development, Implementation, and Lessons Learned.Applied clinical informatics · 2016Trial
- Emergency Department Observation and Computed Tomography Use in Children With Blunt Abdominal Trauma.Annals of emergency medicine · 2026Article
- PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study.The Lancet. Child & adolescent health · 2024Article
- Young children with a minor traumatic head injury: clinical observation or CT scan?European journal of pediatrics · 2022Observational
- Indications for computed tomography use and frequency of traumatic abnormalities based on real-world data of 2405 pediatric patients with minor head trauma.Surgical neurology international · 2021Article
- Aligning Patient Safety and Stewardship: A Harm Reduction Strategy for Children.Current treatment options in pediatrics · 2021Review
- Identification of Abusive Head Trauma in High-Risk Infants: A Cost-Effectiveness Analysis.The Journal of pediatrics · 2020Article
- Developing a framework for evidence-based grading and assessment of predictive tools for clinical decision support.BMC medical informatics and decision making · 2019Review
- Comparison of Machine Learning Optimal Classification Trees With the Pediatric Emergency Care Applied Research Network Head Trauma Decision Rules.JAMA pediatrics · 2019Article
- Grading and assessment of clinical predictive tools for paediatric head injury: a new evidence-based approach.BMC emergency medicine · 2019Review
- Article
- Comparison of minor head trauma management in the emergency departments of a United States and Italian Children's hospital.Italian journal of pediatrics · 2019Article
- Overuse of CT and MRI in paediatric emergency departments.The British journal of radiology · 2018Review
- Reducing the Cranial CT Rate for Pediatric Minor Head Trauma at Three Community Hospitals.Pediatric quality & safetyArticle
- Cost-Effectiveness of Rule-Guided Head Computed Tomography for Pediatric Head Injury: An Economic Modeling Study Using a Nationwide Claims Database.Acute medicine & surgeryArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
STUDY
objectiveTo improve the efficiency and appropriateness of computed tomography (CT) use in children with minor head trauma, clinical prediction rules were derived and validated by the Pediatric Emergency Care Applied Research Network (PECARN). The objective of this study was to conduct a cost-effectiveness analysis comparing the PECARN traumatic brain injury prediction rules to usual care for selective CT use.
methodsWe used decision analytic modeling to project the outcomes, costs, and cost-effectiveness of applying the PECARN rules compared with usual care in a hypothetical cohort of 1,000 children with minor blunt head trauma. Clinical management was directed by level of risk as specified by the presence or absence of variables in the PECARN traumatic brain injury prediction rules. Immediate costs of care (diagnostic testing, treatment [not including clinician time], and hospital stay) were derived on single-center data. Quality-adjusted life-year losses related to the sequelae of clinically important traumatic brain injuries and to radiation-induced cancers, number of CT scans, number of radiation-induced cancers, number of missed clinically important traumatic brain injury, and total costs were evaluated.
resultsCompared with the usual care strategy, the PECARN strategy was projected to miss slightly more children with clinically important traumatic brain injuries (0.26 versus 0.02 per 1,000 children) but used fewer cranial CT scans (274 versus 353), resulted in fewer radiation-induced cancers (0.34 versus 0.45), cost less ($904,940 versus $954,420), and had lower net quality-adjusted life-year loss (-4.64 versus -5.79). Because the PECARN strategy was more effective (less quality-adjusted life-year loss) and less costly, it dominated the usual care strategy. Results were robust under sensitivity analyses.
conclusionApplication of the PECARN traumatic brain injury prediction rules for children with minor head trauma would lead to beneficial outcomes and more cost-effective care.
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