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Master Thesis

Comment optimiser le recours au scanner cérébral dans les traumatismes crâniens légers aux urgences pédiatriques ? : l'intérêt d'un protocole inspiré de la règle de décision clinique du « Pediatric Emergency Care Applied Research Network » (PECARN)

Abstract : Context: mild traumatic brain injury (mTBI) is common in and is associated with considerable mortality and morbidity imputable to intracranial complications. The gold-standard investigation is computed tomography (CT), which reliably detects intracranial complications but is associated with radiation-induced malignancy. Clinical decision rules (CDRs) have been developed to stratify patients according to the risk of intracranial complication and hence indication for CT, such as N. Kupperman’s CDR in 2009 from the "Pediatric Emergency Care Applied Research Network" (PECARN). Objective: efficacy of PECARN CDR and Glasgow scale were investigated for predicting traumatic CT findings in infants who underwent CT for mTBI. Methods: records of children who were admitted to emergency ward and underwent CT imaging because of mTBI during a 4-year period were retrospectively reviewed. Results: sensitivities of PECARN CDR and Glasgow scale were 37% (25%-51%) and 4% (0,7%-20%) and specificities were 94% (90%-96%) and 94% (89%-97%) in detecting traumatic intracranial injury. Youden index, Q coefficient and Khi2 were significant for PECARN CDR. Only 45,5% of reviewed records showed an evaluation of Glasgow scale. Conclusions: using PECARN CDR may offer a guide to TBI management, including a better selection of patients for CT scan compared to a single scale (Glasgow).
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https://dumas.ccsd.cnrs.fr/dumas-02940416
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Submitted on : Wednesday, September 16, 2020 - 11:59:37 AM
Last modification on : Tuesday, October 20, 2020 - 10:31:46 AM

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  • HAL Id : dumas-02940416, version 1

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Hélène Mariette. Comment optimiser le recours au scanner cérébral dans les traumatismes crâniens légers aux urgences pédiatriques ? : l'intérêt d'un protocole inspiré de la règle de décision clinique du « Pediatric Emergency Care Applied Research Network » (PECARN). Médecine humaine et pathologie. 2020. ⟨dumas-02940416⟩

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