Evidence map›Paper›PMID 32943022›Full record

ArticleBMC pediatrics2020

Does implementation of the PECARN rules for minor head trauma improve patient-centered outcomes in a lower resource emergency department: a retrospective cohort study.

Rasha D Sawaya, Cynthia Wakil, Adonis Wazir, Sami Shayya, Iskandar Berbari, Rawan Safa, Maha Makki, Mahdi Hamade, Hani Tamim

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC pediatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
0.6field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 11 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Rasha D SawayaDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Cynthia WakilDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Adonis WazirDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Sami ShayyaDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Iskandar BerbariDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Rawan SafaDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Maha MakkiDepartment of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Mahdi HamadeFaculty of Medicine, American University of Beirut, Beirut, Lebanon.
Hani TamimFaculty of Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon. hani_t@hotmail.com.ORCID 0000-0003-1428-8300
American University of Beirut Medical Center · LBAmerican University of Beirut · LB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundManaging children with minor head trauma remains challenging for physicians who evaluate for the need for computed tomography (CT) imaging for clinically important traumatic brain injury (ciTBI) identification. The Pediatric Emergency Care Applied Research Network (PECARN) prediction rules were adopted in our pediatric emergency department (PED) in December 2013 to identify children at low risk for ciTBI. This study aimed to evaluate this implementation's impact on CT rates and clinical outcomes.

methodsRetrospective cohort study on pediatric patients with head trauma presenting to the PED of the American University of Beirut Medical Center in Lebanon. Participants were divided into pre- (December 2012 to December 2013) and post-PECARN (January 2014 to December 2016) groups. Patients were further divided into < 2 and ≥ 2 years and stratified into groups of low, intermediate and high risk for ciTBI. Bivariate analysis was conducted to determine differences between both groups.

resultsWe included 1362 children of which 425 (31.2%) presented pre- and 937 (68.8%) presented post-PECARN rules implementation with 1090 (80.0%) of low, 214 (15.7%) of intermediate and 58 (4.3%) of high risk for ciTBI. CTs were ordered on 92 (21.6%) pre- versus 174 (18.6%) patients post-PECARN (p = 0.18). Among patients < 2 years, CT rates significantly decreased from 25.2% (34/135) to 16.5% (51/309) post-PECARN (p = 0.03), and dropped in all risk groups but only significantly for low risk patients from 20.7% (24/116) to 11.4% (30/264) (p = 0.02). There was no significant decrease in CT rates in patients ≥2 years (20% pre (58/290) vs 19.6% post (123/628), p = 0.88). There was no increase in bounce back numbers, nor in admission rates or positive CT findings among bounce backs.

conclusionsPECARN rules implementation did not significantly change the overall CT scan rate but reduced the CT scan rate in patients aged < 2 years at low risk of ciTBI. The implementation did not increase the number of missed ciTBI.

Indexed as

Craniocerebral TraumaEmergency Medical ServicesAgedChildDecision Support TechniquesEmergency Service, HospitalHumansInfantLebanonPatient-Centered CareRetrospective StudiesClinically important traumatic brain injuryCT imagingMinor head traumaPECARN prediction rulesPediatric patients

Identifiers

PMID32943022
PMCPMC7499971
OpenAlexW3084624488

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.