title: Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice.
abstract: OBJECTIVE
  The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) age-based clinical prediction rules identify children at very low risk of a significant head injury who can safely avoid CT. Our goal was to independently validate these prediction rules.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Two paediatric emergency departments located in USA and in Italy.
  
  
  METHODS
  All children presenting within 24 h of a head injury with a Glasgow Coma Score of ≥14.
  
  
  METHODS
  Assessment of PECARN TBI clinical predictors.
  
  
  METHODS
  Clinically important TBI defined as head injury resulting in death, intubation for >24 h, neurosurgery or two or more nights of hospitalisation for the management of head trauma.
  
  
  RESULTS
  During the study period, we included 2439 children (91% of eligible patients), of which 959 (39%) were <2 years of age and 1439 (59%) were male. Of the study patients, 373 (15%) had a CT performed, 69 (3%) had traumatic findings on their CT and 19 (0.8%) had a clinically important TBI. None of the children with a clinically important TBI were classified as very low risk by the PECARN TBI prediction rules (overall sensitivity 100%; 95% CI 83.2% to 100%, specificity 55%, 95% CI 52.5% to 56.6%, and negative predictive value 100%, 95% CI 99.6% to 100%).
  
  
  CONCLUSIONS
  In our external validation, the age-based PECARN TBI prediction rules accurately identified children at very low risk for a clinically significant TBI and can be used to assist CT decision making for children with minor blunt head trauma.
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, , Boston, Massachusetts, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Schonfeld
authors.forename: Silvia
authors.initials: S
authors.lastname: Bressan
authors.forename: Liviana
authors.initials: L
authors.lastname: Da Dalt
authors.forename: Mira N
authors.initials: MN
authors.lastname: Henien
authors.forename: Jill A
authors.initials: JA
authors.lastname: Winnett
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007558:Italy; D008297:Male; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014481:United States
keywords: Accident & Emergency; Epidemiology