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, 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

R. De, L. A. These, and . Français,

, Contexte : Les traumatismes crâniens légers (TCL) sont fréquents et peuvent être associés à des lésions intracrâniennes (LIC) avec un risque non nul de morbi-mortalité. L'examen de référence pour faire le diagnostic de LIC est le scanner cérébral

, Des règles de décision clinique (RDC) comme celle réalisée par N Kupperman au nom du « Pediatric Emergency Care Applied Research Network » (PECARN) en 2009 ont pour objectif de mieux sélectionner la population à qui est réalisée un scanner cérébral pour TCL. Objectif : Evaluer les performances diagnostiques dans la détection des LIC en cas de scanner pour TCL de la, L'utilisation de cet examen diagnostique doit cependant être justifiée et balancée au risque de tumeur solide et de leucémie associé à son irradiation

, Résultats : Les critères de haut risque de LIC de la RDC du PECARN et un Glasgow <15 ont respectivement une sensibilité de 37% (25%-51%) et de 4% (0,7%-20%) et une spécificité de 94% (90%-96%) et de 94% (89%-97%) pour une détection de LIC. L'indice de Youden, le coefficient Q de Yule et le khi-2 sont significatifs uniquement pour la RDC du PECARN. Le score de Glasgow n'était coté que dans 45,5% des dossiers. Conclusion : Les critères de la RDC du PECARN semblent être supérieurs au score de Glasgow seul pour une détection de LIC en cas de scanner pour TCL, Méthode : Les enfants ayant reçu un scanner cérébral dans les 24h suivant un TCL consultant aux urgences pédiatriques au CHU de CAEN de février 2015 à février 2019 ont été inclus

T. Mots-cles-;-enfant, L. A. De, . These, and . Anglais, Traumatisme crânien, lésion intracrânienne, règle de décision clinique, scanner cérébral

R. De, L. A. These, and . Anglais, How to limit the increasing CT (Computed tomography) use for children with mild traumatic brain injury (mTBI) in pediatric emergency ward? Clinical decision rules (CDRs) similar to the PECARN CDR may hence indication for CT in mTBI management

, 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

, 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 Khi-2 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, Efficacy of PECARN CDR and Glasgow scale were investigated for predicting traumatic CT findings in infants who underwent CT for mTBI

. Key-words, Mild traumatic brain injury, Intracranial complication, Computed tomography, Clinical decision rule, Infant