On the Shoulders of Giants
When a child has a head injury, how do you determine if a head CT is indicated? This was the landmark study to answer that question, 42,000 patients strong. I could proliferate words, but the brand new PECARN/ALiEM/Canadiem visual decision aids make it much simpler with 2 pictures (see at the bottom of the post). If you know these, you know the PECARN rule.
These new visual decision aids distill this massive study into 2 simple images. ALiEM encourages you to download them on their site for free. Please don’t screenshot; links are below.
Study these carefully. I can’t overemphasize how important this study is and how much it has changed my practice and approach as I discuss this with families.
Here is the visual decision aid for kids < 2 years.
Here is the visual decision aid for kids > 2 years.
You can also learn more on MDCalc. It walks you step by step through the rule.
Most importantly, this is an article you need to read. It’s truly a landmark and well worth your time.
You need to know this decision rule cold. Before doing a head CT on any child, think through this decision aid first. Scanning fewer children may reduce the chance of malignancy down the road.
Much has been written on this study. Here are some of the best FOAM posts.
- WikEM has a deep-dive play-by-play analysis of the article.
- ALiEM has an expert peer-reviewed post on this article you must read by Josh Easter.
- EMCases also has an outstanding podcast and written summary on this.
Source – Read this one for yourself
Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70. doi: 10.1016/S0140-6736(09)61558-0. Epub 2009 Sep 14.
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