title: Cost-effectiveness of the PECARN rules in children with minor head trauma.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Compared 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.
  
  
  CONCLUSIONS
  Application of the PECARN traumatic brain injury prediction rules for children with minor head trauma would lead to beneficial outcomes and more cost-effective care.
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA. Electronic address: daniel.nishijima@ucdmc.ucdavis.edu.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.affiliation: Center for Healthcare Policy and Research, UC Davis School of Medicine, Sacramento, CA.
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Economics and Related Studies, University of York, Heslington, York.
authors.forename: Michael
authors.initials: M
authors.lastname: Urbich
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
authors.affiliation: Department of Neurological Surgery, UC Davis School of Medicine, Sacramento, CA.
authors.forename: Marike
authors.initials: M
authors.lastname: Zwienenberg-Lee
authors.affiliation: Center for Healthcare Policy and Research, UC Davis School of Medicine, Sacramento, CA.
authors.forename: Joy
authors.initials: J
authors.lastname: Melnikow
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, CA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001930:Brain Injuries / Q000000981:diagnostic imaging / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging* / Q000191:economics; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital / Q000191:economics; D023261:Glasgow Outcome Scale; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010043:Outcome and Process Assessment, Health Care; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome