Background

Pediatric minor head trauma approaches aim to ensure the absence of traumatic brain lesions, minimize ionizing radiation, and enhance cost control. We evaluated the applicability and cost-effectiveness of the Pediatric Emergency Care Applied Research Network (PECARN) rules after head trauma and rationalize the use of head computed tomography (CT) scans.

Methods

We retrospectively divided patients <18 years old who presented at a single institution in Brazil with minor head trauma into four groups: Group I (skull X-ray only), Group II (head CT only), Group III (X-ray and CT), and Group IV (observation only). Direct costs were calculated based on examination and length of hospitalization. The PECARN rules were applied retrospectively in each patient to determine who required a CT scan, and the costs were re-calculated.

Results

Of the 1328 patients, CT scans were performed in 36.4% and X-rays in 52.6%. The mean cost was USD 5.88, 34.58, 41.85, and 4.04 for Groups I–IV, respectively. After applying the PECARN rules, 77.6% of patients no longer required a CT scan, and overall costs were reduced from USD 16.71 to 7.88 (p < .001). Conclusion: The PECARN rules demonstrated a meaningful cost-effectiveness and should be applied to the Brazilian pediatric population.

中文翻译：

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巴西的小儿头部外伤，并通过成本效益分析对PECARN规则进行外部验证。

背景

儿科较小的头部外伤方法旨在确保没有外伤性脑损伤，最小化电离辐射并增强成本控制。我们评估了颅脑外伤后小儿急诊应用研究网络（PECARN）规则的适用性和成本效益，并合理使用了头部计算机断层扫描（CT）扫描。

方法

我们将在巴西的一家机构中出现头部轻微创伤的<18岁患者进行回顾性分析，分为四组：第一组（仅颅骨X射线），第二组（仅颅骨CT），第三组（X射线和CT） ）和第IV组（仅用于观察）。根据检查和住院时间计算直接费用。回顾性地将PECARN规则应用于每位患者，以确定谁需要CT扫描，然后重新计算费用。

结果

在1328例患者中，CT扫描占36.4％，X射线占52.6％。I-IV组的平均成本分别为5.88美元，34.58、41.85和4.04美元。在应用PECARN规则后，77.6％的患者不再需要CT扫描，并且总成本从16.71美元减少到7.88美元（p <.001）。结论：PECARN规则显示出有意义的成本效益，应适用于巴西儿科人群。