Variability in the management of infants under 3 months with minor head injury in paediatric emergency departments.

Autor:	Alonso-Cadenas JA; Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain. Electronic address: jalonsocadenas@gmail.com., Calderón Checa RM; Servicio de Urgencias, Hospital Universitario Materno-Infantil Doce de octubre, Madrid, Spain., Ferrero García-Loygorri C; Servicio de Urgencias, Hospital Universitario Materno-Infantil Gregorio Marañón, Madrid, Spain., Durán Hidalgo I; Servicio de Urgencias, Hospital Universitario Materno-Infantil Málaga, Málaga, Spain., Pérez García MJ; Servicio de Pediatría, Hospital Universitario Puerta De Hierro, Majadahonda, Madrid, Spain., Delgado Gómez P; Servicio de Urgencias, Hospital Universitario Materno-Infantil Virgen del Rocío, Sevilla, Spain., Jiménez García R; Servicio de Urgencias, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Anales de pediatria [An Pediatr (Engl Ed)] 2023 Feb; Vol. 98 (2), pp. 83-91. Date of Electronic Publication: 2023 Feb 06.
DOI:	10.1016/j.anpede.2022.10.010
Abstrakt:	Introduction: In the assessment of infants younger than 3 months with minor traumatic head injury (MHI), it is essential to adapt the indication of imaging tests. The Pediatric Head Injury/Trauma Algorithm (PECARN) clinical prediction rule is the most widely used to guide clinical decision making. Objectives: To analyse the variability in the performance of imaging tests in infants under 3 months with MHI in paediatric emergency departments (PEDs) and the adherence of each hospital to the recommendations of the PECARN rule. Population and Methods: We conducted a prospective multicentre observational study in 13 paediatric emergency departments in Spain between May 2017 and November 2020. Results: Of 21 981 children with MHI, 366 (1.7%) were aged less than 3 months; 195 (53.3%) underwent neuroimaging, with performance of CT scans in 37 (10.1%; interhospital range, 0%-40.0%), skull X-rays in 162 (44.3 %; range, 0%-100%) and transfontanellar ultrasound scans in 22 (6.0%; range, 0%-24.0%). The established recommendations were followed in 25.6% (10/39) of infants classified as high-risk based on PECARN criteria (range, 0%-100%); 37.1% (36/97) classified as intermediate-risk (range, 0%-100%) and 57.4% (132/230) classified as low-risk (range, 0%-100%). Conclusion: We found substantial variability and low adherence to the PECARN recommendations in the performance of imaging tests in infants aged less than 3 months with MHI in Spanish PEDs, mainly due to an excessive use of skull X-rays. (Copyright © 2022 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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