Head-to-head comparison of pediatric TBI screening tools yields a winner

  • Shavit I & al.
  • J Surg Res
  • 20.08.2019

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • In screening for pediatric clinically important traumatic brain injury (ciTBI), the Pediatric Emergency Care Applied Research Network (PECARN) decision rule bests the Israeli Decision Algorithm for Identifying TBI in Children (IDITBIC) in identifying low-risk children.

Why this matters

  • The authors say their findings indicate that clinicians should “strongly consider” sending children with Glasgow Coma Score

Key results

  • With IDITBIC, 11 patients with ciTBI would have been missed.
  • This number was 1 with PECARN. 
  • In children less than age 2 years, IDITBIC had a sensitivity of 95.2%, specificity of 79.5%, positive predictive value of 3.8%, and negative predictive value of 99.9%.
  • The corresponding values for PECARN were 100.0%, 59.1%, 2.0%, and 100.0%.
  • In children age 2-plus years, these values were 92.4%, 75.3%, 3.1%, and 99.9% for IDITBIC and 99.2%, 52.9%, 1.7%, and 100.0% for PECARN.

Study design

  • Multicenter international cohort study of 18,913 children (mean age, 5.7 years; 63.8% males) with a Glasgow Coma Score of 13-15 who presented to the emergency department within 24 hours of injury.
  • Funding: Government and foundation grants.

Limitations

  • IDITBIC is for screening for high risk and PECARN for low risk.
  • 2 other potential decision rules were not included.
  • Data from regional populations (Australia, New Zealand).