title: Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study.
abstract: BACKGROUND
  To date, the Pediatric Emergency Care Applied Research Network (PECARN) rule for identifying children who are at very low risk of clinically-important traumatic brain injuries after minor head trauma has not been validated prospectively in an independent population. Our goal was to evaluate the diagnostic performance of the PECARN clinical decision rule in a French pediatric population in multiple clinical settings.
  
  
  METHODS
  We conducted a multicenter, prospective, non-interventional cohort study of patients with minor head trauma who presented to three emergency departments in France. We enrolled patients younger than 16 years of age seeking a consultation within 24 h of head trauma with Glasgow Coma Scale scores of 14-15.
  
  
  RESULTS
  During the study period, we included 1499 children of which 421 (28 %) were under 2 years of age, and 955 (64 %) were male. A cranial computed tomography (CT) scan was performed on 76 patients (5.1 %). Of the 1499 included patients, 9 children (0.6 %) had a clinically-important traumatic brain injury, and none were classified as very low risk by the PECARN rule. In our study, the sensitivity of this clinical decision rule was 100 % (95 % CI 66.4 to 100 %), the specificity was 69.9 % (95 % CI 67.5 to 72.2 %) and the negative predictive value was 100 % (95 % CI 99.7 to 100 %).
  
  
  CONCLUSIONS
  Our study confirmed the good predictive performances of the PECARN clinical decision rule for minor head trauma in children. The PECARN rule performed similarly to our study and to its internal validation study.
  
  
  CONCLUSIONS
  We conducted an external validation study of the PECARN clinical decision rule for the detection of clinically-important traumatic brain injuries in children with minor head trauma, according to the methodological standards. The PECARN rule successfully identified all patients with clinically-important traumatic brain injuries, with a limited use of CT scans. Conducting a broad validation study with a large cohort is a prerequisite to provide sufficient statistical power before authorizing its implementation and generalization.
  
  
  BACKGROUND
  This study has been registered in ClinicalTrials.gov with identifier number: NCT02752711 on April 27, 2016.
authors.affiliation: Department of Pediatric Emergency, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France. fleur.lorton@chu-nantes.fr.|INSERM CIC 1413, University Hospital, 38 bd Jean Monnet, 44093, Nantes Cédex 01, France. fleur.lorton@chu-nantes.fr.
authors.forename: F
authors.identifier: http://orcid.org/0000-0003-0921-4622
authors.initials: F
authors.lastname: Lorton
authors.affiliation: Department of Pediatric Emergency, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France.
authors.forename: C
authors.initials: C
authors.lastname: Poullaouec
authors.affiliation: Department of Pediatric Emergency, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France.
authors.forename: E
authors.initials: E
authors.lastname: Legallais
authors.affiliation: Department of Pediatric Emergency, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France.
authors.forename: J
authors.initials: J
authors.lastname: Simon-Pimmel
authors.affiliation: Department of Pediatrics, Hospital of Saint-Nazaire, 11 bd Georges Charpak, 44 606, Saint-Nazaire Cédex, France.
authors.forename: M A
authors.initials: MA
authors.lastname: Chêne
authors.affiliation: Department of Emergency, Departmental Hospital of Vendée, Les Oudairies, 85925, La Roche sur Yon Cédex 9, France.
authors.forename: H
authors.initials: H
authors.lastname: Leroy
authors.affiliation: Department of Pediatric Emergency, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France.
authors.forename: M
authors.initials: M
authors.lastname: Roy
authors.affiliation: Department of Pediatrics, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France.
authors.forename: E
authors.initials: E
authors.lastname: Launay
authors.affiliation: Department of Pediatric Emergency, University Hospital, Quai Moncousu, 44093, Nantes Cédex 01, France.|INSERM CIC 1413, University Hospital, 38 bd Jean Monnet, 44093, Nantes Cédex 01, France.
authors.forename: C
authors.initials: C
authors.lastname: Gras-Le Guen
mesh_terms: D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003657:Decision Making; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005602:France / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed
keywords: Children; Clinical decision rule; Cranial computed tomography; External validation; Minor head trauma