Impact of The Adoption of PECARN Protocol in reduce requests of Head CTs for TBI between 2 and 14 years: Italian Experience

Background: to avoid brain CTs in pediatric age various protocols have been proposed. We evaluate security of adherence to PECARN protocol in the real life of a 2nd level Italian trauma center

Objective: evaluate whether adherence to PECARN reduce requests of head CTs performed in a pediatric population admitted to a level 2 trauma center because of a TBI.

Methods: Data of patients aged ≤14 years and admitted to the emergency department of Foundation IRCCS Policlinic San Matteo, Pavia, Italy, in 2019 because of a TBI were retrospectively reviewed. PECARN protocol was applied in all patients. Neurosurgical consultancy was requested in case of medium-high risk TBI or age

Results: We enrolled 452 patients aged older than 2 years ( average age 6). 48.2% came from a domestic accident, 1.9% from violence by others, 7.9% from a sports accident, 14.6 from a school accident, 5.7% from a road accident, and the remainder from other causes. 98.9% were discharged and only 0.2% were admitted for observation in pediatrics. The remainder preferred home observation despite medical recommendations. None of the patients had an elevated (yellow or red) severity code at discharge. The average waiting times for the medical examination were 48 minutes with a median of 33 minutes. The overall hospital stay in the emergency room was on average 111 minutes with a median of 92 minutes. 1.99% of patients had a re-visit within the next day and a complex of 4.86% within 5 days. None of the patients had complications due to the fall at follow-up. Radiological requests with this protocol remained under 1% of accesses, without any subsequent serious complications.

Conclusion: The implementation of PECARN protocol was effective in keeping very low the overall volume of head CTs performed because of a pediatric TBI, ultimately limiting the risk of radiation exposure.