경증 두부외상을 가진 소아환자의 뇌 전산화단층시행 감소를 위한 PECARN rule 교육의 효과
The effect of introducing Pediatric Emergency Care Applied Research Network rule on reducing brain computed tomography use for children with minor head injury
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Purpose: Computed tomography (CT) scan is an effective modality for detecting fatal traumatic brain injury. However, radiation exposure from CT can increase the risk of cancer, and children are more vulnerable to radiation than adults. We aimed to investigate the effect of introducing the Pediatric Emergency Care Applied Research Network (PECARN) rule to the emergency department (ED). Methods: Medical records of children younger than 2 years with minor head injury who visited ED from January 2013 to June 2015 were reviewed. We started the education of radiation hazard and the PECARN rule in January 2014. The children were divided into pre- and post- education groups. The baseline characteristics, CT rate, and clinical outcomes were analyzed. The safety and efficacy of CT were defined as patients who received head CT scan per those experiencing clinically important traumatic brain injury (ciTBI) and patients without CT scan per those without ciTBI, respectively. Results: Of 911 patients, 360 (39.5%) visited during the post-education period. Median age was 16.0 months (interquartile range, 11.0-20.0 months), and boys accounted for 58.5%. CT rate was reduced from 40.5% to 12.8% (P < 0.001). There was no difference in ciTBI rates between the two groups (1.3% vs. 1.7%, P = 0.622). The safety was 100% in both periods and the efficacy increased from 52.9% to 88.7%. Conclusion: We have seen a significant decrease in CT rate through the education of the PECARN rule. After its introduction, CT use was reduced, and the efficacy was improved without decrease in the safety.
Abstract
Purpose: Computed tomography (CT) scan is an effective modality for detecting fatal traumatic brain injury. However, radiation exposure from CT can increase the risk of cancer, and children are more vulnerable to radiation than adults. We aimed to investigate the effect of introducing the Pediatric Emergency Care Applied Research Network (PECARN) rule to the emergency department (ED). Methods: Medical records of children younger than 2 years with minor head injury who visited ED from January 2013 to June 2015 were reviewed. We started the education of radiation hazard and the PECARN rule in January 2014. The children were divided into pre- and post- education groups. The baseline characteristics, CT rate, and clinical outcomes were analyzed. The safety and efficacy of CT were defined as patients who received head CT scan per those experiencing clinically important traumatic brain injury (ciTBI) and patients without CT scan per those without ciTBI, respectively. Results: Of 911 patients, 360 (39.5%) visited during the post-education period. Median age was 16.0 months (interquartile range, 11.0-20.0 months), and boys accounted for 58.5%. CT rate was reduced from 40.5% to 12.8% (P < 0.001). There was no difference in ciTBI rates between the two groups (1.3% vs. 1.7%, P = 0.622). The safety was 100% in both periods and the efficacy increased from 52.9% to 88.7%. Conclusion: We have seen a significant decrease in CT rate through the education of the PECARN rule. After its introduction, CT use was reduced, and the efficacy was improved without decrease in the safety.
참고문헌 (22)
- Hawley CA, "Prevalence of traumatic brain injury amongst children admitted to hospital in one health district: a populationbased study", Injury, 34, pp.256~260 (2003)
- Hyder AA, "The impact of traumatic brain injuries: a global perspective", NeuroRehabilitation, 22, pp.341~353 (2007)
- Holmes JF, "Performance of the pediatric glasgow coma scale in children with blunt head trauma", Acad Emerg Med, 12, pp.814~819 (2005)
- Kuppermann N, "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study", Lancet, 374, pp.1160~1170 (2009)
- Pearce MS, "Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study", Lancet, 380, pp.499~505 (2012)
- Osmond MH, "CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury", CMAJ, 182, pp.341~348 (2010)
- Sun BC, "Evaluation of a modified prediction instrument to identify significant pediatric intracranial injury after blunt head trauma", Ann Emerg Med, 49, pp.325-32.e1~ (2007)
- Easter JS, "Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study", Ann Emerg Med, 64, pp.145-52.e1~145-52.e5 (2014)
- Lyttle MD, "Comparing CATCH, CHALICE and PECARN clinical decision rules for paediatric head injuries", Emerg Med J, 29, pp.785~794 (2012)
- Babl FE, "Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study", Lancet, 389, pp.2393~2402 (2017)
- Jung KY, "Availability of the Pediatric Emergency Care Applied Research Network (PECARN) rule for computed tomography scanning decision in children younger than 2 years with minor head injury", Pediatr Emerg Med J, 2, pp.67~74 (2015)
- Hwang JY, "A survey of pediatric CT protocols and radiation doses in South Korean hospitals to optimize the radiation dose for pediatric CT scanning", Medicine (Baltimore), pp.94:e2146~ (2015)
- Reilly BM, "Translating clinical research into clinical practice: impact of using prediction rules to make decisions", Ann Intern Med, 144, pp.201~209 (2006)
- Kocher KE, "National trends in use of computed tomography in the emergency department", Ann Emerg Med, 58, pp.452.e3~462.e3 (2011)
- Brenner DJ, "Computed tomography: an increasing source of radiation exposure", N Engl J Med, 357, pp.2277~2284 (2007)
- Malviya S, "Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes", Br J Anaesth, 84, pp.743~748 (2000)
- 박소영, "건강보험심사평가원 환자표본자료를 이용한 국내 두부손상의 역학 및 뇌 CT 시행 분석", 대한외상학회지, 25(4), pp.152~158 (2012), 대한외상학회
- 김한범, "Epidemiology of Traumatic Head Injury in Korean Children", Journal of Korean Medical Science, 27(4), pp.437~442 (2012), 대한의학회[DOI]
- Bressan S, "The Pediatric Emergency Care Applied Research Network intermediate-risk predictors were not associated with scanning decisions for minor head injuries", Acta Paediatr, 104, pp.47~52 (2015)
- Lorton F, "Validation of the PECARN clinical decision rule for children with minor head trauma:a French multicenter prospective study", Scand J Trauma Resusc Emerg Med, 24, pp.98~ (2016)
- Puffenbarger MS, "Reduction of computed tomography use for pediatric closed head injury evaluation at a nonpediatric community emergency department", Acad Emerg Med, 26, pp.784~795 (2019)
- Kobe IO, "The impact of the introduction of PECARN head CT rules on the utilisation of head CT scans in a private tertiary hospital in Sub-Saharan Africa", Childs Nerv Syst, 33, pp.2147~2152 (2017)