ABSTRACT
Objetivo: Determinar si la aplicación de las reglas de la Red de Investigación Aplicada de Atención de Emergencia Pediátrica (PECARN) disminuye el uso de tomografías simples de cráneo en pacientes con traumatismo cráneo encefálico leve dentro de las primeras 24 horas, determinar la sensibilidad y especificidad de las reglas PECARN Lugar: Servicio de Emergencias del Hospital del Niño" Dr. Luis Ovidio Aliaga Uría" Participantes: 56 pacientes que acudieron al servicio de emergencias por traumatismo cráneo encefálico leve. Mediciones: se evaluó todas las variables que incluyen las reglas de PECARN. Resultados.- Se realizó la comparación en relación al número de tomografías pre y post implementación de las reglas PECARN evidenciándose una disminución del 78.4% (69/88) al 66.6% (36/56) post-PECARN (p = 0,01), y descendieron de forma significativa para los pacientes de bajo riesgo. Post PECARN se incluyeron 56 pacientes se dividen en alto riesgo 15 pacientes (26.7%), se realizó tomografía 100%, evidenciándose lesiones cerebrales en el 100%, 21 pacientes (37.5%) como pacientes de riesgo medio, se decidió realizar tomografía en el 100%, de los cuales 42.8% presentaron lesiones cerebrales. Dentro de los pacientes con bajo riesgo se clasificaron a 20 pacientes (35.7%), ninguno fue sometido a tomografía simple de cráneo debido al bajo riesgo. Se evidencio en este estudio, la sensibilidad de esta regla de decisión clínica fue del 100%, la especificidad fue del 62,5% y el valor predictivo negativo fue del 100%.
Subject(s)
Brain Injuries, TraumaticABSTRACT
Objective To explore the applicability of the three commonly used CT examination decision rules in Chinese head injured children. Methods This prospective observational study included 1538 children and adolescents (aged < 18 years), who were treated at the Emergency Department of First Hospital of Shanxi Medical University after head injuries. The three clinical decision rules include the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE; UK); the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury, that was developed by the Pediatric Emergency Care Applied Research Network (PECARN; USA), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule. Diagnostic accuracy had been evaluated by using the rule-specific predictor variables to predict each rule-specific outcome measure in populations who met inclusion and exclusion criteria for each rule. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and ROC curve were referred to the diagnostic accuracy. Indicators were characterized by 95％ CI. Results Of the 1538 patients, CTs were obtained for 339 patients (22.04％). Forty-nine patients (3.19％) had positive CT results, 8 patients (0.52％) underwent neurosurgery, 2 patients (0.13％) died, and 1 patient (0.07％) may be missed. In this study, CHALICE was applied for 1394 children (90.70％; 95％ CI: 89.24％-92.15％), PECARN for 801 children (52.11％; 95％ CI: 49.62％-54.61％), and CATCH for 325 patients (21.15％; 95％CI: 19.10％-23.19％). The validation sensitivities of CHALICE, PECARN, and CATCH rules were 92.6％(74.2％-98.7％), 100％ (56.1％-100％), and 85.7％ (42.0％-99.2％), respectively; the specificities were 78.1％(75.7％-80.2％), 48.0％ (44.5％-51.5％) and 70.8％ (65.4％-75.6％); positive predictive value were 7.7％ (5.1％-11.3％), 0.9％ (0.4％-1.9％) and 6.1％ (2.5％-13.2％); and negative predictive value were 99.8％ (99.2％-100％), 99.1％ (98.1％-99.6％), and 99.6％ (97.2％-100％), respectively. Conclusions The clinical decision rules of CHALICE, PECARN and CATCH have high sensitivities. The specificity of PECARN rule is lower than those of CHALICE and CATCH rules. The above three clinical decision rules can be used for the decision of CT examination in Chinese children with head injury in practice.