A 3 year old comes in after falling 3 feet from the top of a kiddie slide onto cement, hitting his head. His only +PECARN symptom is 2 episodes of vomiting in the 2 hours since the fall. The medical student seeing him states to you that he is PECARN+ and he has discussed CT with the parents. What is the approximate risk of clinically important traumatic brain injury in this patient?
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August 17, 2017 at 12:56 pm
A. 0.2% if no other symptoms at all, B. 1% (0.7% actually) if just no other PECARN symptoms
The first thing to remember is that the PECARN head trauma “rule” recommends CT OR observation for patients who are PECARN “positive.” The individual elements of the rule(s) making a patient “positive” vary in how predictive they are of clinically important traumatic brain injury. It is also important to remember the inclusion criteria for the study; patients with trivial mechanisms of injury (eg fall from a ground height) and no signs/symptoms of major head trauma are excluded and the rule does not apply to these patients at all. Isolated vomiting and no other concerning symptoms or signs resulted in a 0.2% risk of clinically important TBI. Isolated vomiting and no other PECARN symptoms in 2-18yo resulted in 0.7% ciTBI. For a detailed summary of the original PECARN study, as well as subsequent publications investigating subsets of patients with just one PECARN symptoms positive, scroll down from the head trauma algorithm on PEMsource http://pemsource.org/wp-content/uploads/2016/04/Head-Trauma.pdf