We should all love PECARN. I love PECARN (Pediatric Emergency Care Applied Research Network) – and not just because I helped set it up as a research assistant peon before medical school. I love it because it takes multicenter enrollment cohorts to conduct adequately powered research in a population that is rarely affected by serious morbidity and mortality.
Of 13,543 children with GCS 14 or 15 and a normal CT scan, none needed neurosurgical intervention in their follow-up period. A small handful of these patients had a repeat CT or MRI for some reason, and between 10-25% of the hospitalized patients and 2-10% of the discharged patients had an abnormal result on repeat imaging. None led to any intervention…which then, of course, begs the question whether it was appropriate to perform a test that did not result in meaningful change in management. But, there’s not enough patients in this group to draw conclusions as to whether repeat scans should or should not be performed.
My only caveat – when you take an over-utilized test in which nearly all patients are certainly fine and will continue to be fine, you actually dilute its external validity to the patient population that really matters. However, even in a higher-risk patient population in which CTs are used far more conservatively, the clinically relevant answer is still going to be same – the only reasonable practice is still going to be to discharge these patients home.
“Do children with blunt head trauma and normal cranial tomography scan results require hospitalization for neurologic observation?”
www.ncbi.nlm.nih.gov/pubmed/21683474