EM Basic Essential Evidence- PECARN Head CT Rule

EM Basic

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Residency, Student, Medicine, Er, Em, Intern, Health & Fitness, Medical, Education, Emergency

4.6 • 665 Ratings

🗓️ 29 October 2012

⏱️ 12 minutes

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Summary

This episode reviews the article that most people call the PECARN head CT rule or the Kupperman head CT rule (named for the first author). This is an easy to use clinical decision rule that can help us reduce the number of head CTs that we do on children with minor head injury. We owe it to our patients to spare them excess radiation, cost, and time in the ED and this rules helps us do this. In order to use this rule effectively, you need to read this article and understand how the study was done. This allows us to understand the strengths and weaknesses of this rule and helps us apply it in our everyday practice.

Transcript

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0:00.0	This is Steve Carroll, and you're listening to EM Basic Essential Evidence. Today we're going to talk
0:05.7	about the study behind what most people call either the P. Karn-Head-C-T rule or the Cooperman
0:11.8	head-C-T rule. This clinical decision rule helps us avoid CT scanning in pediatric patients who sustain
0:19.4	minor head trauma.
0:26.5	It helps us save the patient from an unnecessary head CT and its radiation, so we should be using this rule as much as possible.
0:28.7	So let's get started.
0:29.7	As always, this podcast doesn't represent the views or opinions of the Department of Defense,
0:33.0	U.S. Army, or the Fort Hood Post Command.
0:35.7	The title of this article is identification of children at very low risk of clinically important brain injuries
0:42.4	after head trauma, a prospective cohort study. The study was published in the Lancet,
0:48.2	October 3, 2009, and the first author is Nathan Cooperman. If you go to eMbasid.org, there's a link for free full
0:56.1	text to access to this article. This study was conducted by the Pediatric Emergency Care Applied
1:02.0	Research Network, also called Pekarn. This is a network of 21 hospitals that is pulling their
1:08.7	data together to answer some basic questions in pediatric
1:12.3	emergency medicine. The goal of this study was to create a clinical decision rule that could help
1:18.4	clinicians avoid getting head CTs in children with minor head trauma. The study had two
1:24.6	parts, a derivation group and a validation group.
1:28.3	In the derivation group, the study collected a whole bunch of clinical data points on 8,500 children with minor head trauma.
1:36.0	These data points included such variables as whether there was a loss of consciousness or a headache.
1:41.7	These data points were recorded in the ED during regular patient care.
1:45.9	The study did not interfere with the decision whether or not to get a head CT. That was left up to the
1:51.9	attending physician. The children in the study were then followed to see which patients had a clinically
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