Pediatric Population under the Age of 2 and the use of Brain CTts In Emergency Department Real Life

Background: CT scan is the gold standard for the emergency evaluation of traumatic brain injury (TBI), but pediatric patients are at risk of radiation, especially under two years of age. Pediatric Emergency Care Applied Research Network (PECARN) propagated a protocol for the careful selection of children to undergo CTs.

Objective: Evaluate whether the adherence to PECARN protocol kept low the volume of head CTs performed in a pediatric population under 2 years of age.

Methods: We enrolled patients aged ≤ 2 years who are consecutively referred to our emergency room from January 1st to December 31st 2018 for TBI.

Results: We enrolled 250 patients. 88.4% came from domestic accidents, 0% from violence of others, 1.2% from road accidents, and the remainder from other causes. 98.4% accessed the medical examination with a low priority code and required low intensity of care, 1.6% required high priority to the medical examination and the overall 0.4% required medium or high intensity of care. 95.2% were discharged and only 2.4% were hospitalized for observation in pediatrics. The remaining 2.4% preferred home observation despite medical recommendations. Only 0.8% of patients had a high (yellow or red) severity code at discharge. The average waiting times for the medical examination were 30 minutes. The overall hospital stay in the emergency room was on average 118 minutes. 2.8% of patients had a re-visit within the next day and a complex of 3.6% 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 application of this protocol in the pediatric population under the age of 2 has resulted in a low request for CT scan of the brain with low radiation exposure of patients.