Abstract
Objectives
To evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children.
Methods
A before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay.
Results
We included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules.
Conclusions
The implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI.
Acknowledgments
The authors thank Drs. Baptiste Dumortier, Juliette Foucher and Maelle Lorvellec for participating in the data collection.
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Research funding: None declared.
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interest: FL has received travel grants from Pfizer, JSP has received travel grants from Roche Diagnostics, DM has received travel grants from Roche Diagnostics, EL has received travel grants from GSK, CGL has received travel grants from GSK, AbbVie, Astellas Pharma, bioMérieux, Chiesi SAS and Pfizer, fees from Pfizer, AbbVie and Roche Diagnostics. No other relationships or activities could appear to have influenced the submitted work.
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Ethical approval: Research involving human subjects complied with all relevant national regulations, institutional policies and is in accordance with the tenets of the Helsinki Declaration.
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2020-1293).
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