title: Traumatic Brain Injury in Children: Role of CDRs-PECARN as a Clinical Predictive Resource for Evaluation of Intracranical Lesions and Neuropsychiatric Outcomes.
abstract: Cranial computed tomography (CT) is considered the gold standard for the diagnosis of traumatic brain injury (TBI). The aim of this study was to evaluate if the clinical decision rules proposed by the Pediatric Emergency Care Applied Research Network (CDRs-PECARN) are really able to identify the patients who do not need cranial CT. This study investigates the neuropsychiatric outcome after TBI according to a pediatric version of the Glasgow Outcome Scale-Extended (GOS-E Peds). We calculated the sensitivity, specificity, negative predictive value (NPV) and positive predictive value of the CDRs-PECARN in 2 age groups. Sensitivity was very high in both groups, and the NPV was very useful for predicting which subjects, of those who presented without CDRs- PECARN, would have a negative cranial CT. We also evaluated the correlations between the GOS-E Peds and Glasgow Coma Scale and between the GOS-E Peds and cranial CT scan. Our study confirms the validation of the PECARN TBI prediction rules as a clinical instrument which can play a significant role in CT decision-making for children with TBI. It also demonstrates that the GOS-E Peds is a valid pediatric outcome scale for children with TBI, despite some important limitations.
authors.affiliation: Institute of Pediatrics, Catholic University Medical School, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ferrara
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Basile
authors.forename: Livia
authors.initials: L
authors.lastname: Dell'Aquila
authors.forename: Flaminia
authors.initials: F
authors.lastname: Vena
authors.forename: Elena
authors.initials: E
authors.lastname: Coppo
authors.forename: Antonio
authors.initials: A
authors.lastname: Chiaretti
authors.forename: Alberto
authors.initials: A
authors.lastname: Verrotti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Paolini
authors.forename: Massimo
authors.initials: M
authors.lastname: Caldarelli
mesh_terms: D000293:Adolescent; D000070642:Brain Injuries, Traumatic / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D009483:Neuropsychological Tests; D010372:Pediatrics / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods