Rural Emergency Medicine Podcast Episode 10: Pediatric Head Injury
Jun 21, 2018
The discussion centers on effectively managing pediatric head injuries in rural settings while providing emotional support to anxious parents. It highlights a substantial study of over 40,000 children, showcasing the standardized CT scan decision rules. The podcast emphasizes using algorithms for deciding when a CT scan is necessary and the importance of clear communication with parents. Observing symptoms, especially in children under two, is crucial, alongside the application of the PCARN guidelines to balance effective care with minimized unnecessary imaging.
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PCARN Study Validity and Scope
- The PCARN study included over 42,000 children, giving strong validity to the CT decision rule.
- It applies across various hospital types, including rural, urban, academic, and children's hospitals nationwide.
PCARN Sensitivity in Pediatric Head Injury
- The PCARN rule is 100% sensitive for children under 2 and 96% sensitive for those over 2.
- Subsequent validation studies confirmed 100% sensitivity in both age groups.
Case: Toddler with Vomiting Post-Fall
- A 25-month-old fell and hit his head with no loss of consciousness but vomited twice and had reduced energy the next day.
- PCARN guided the decision for CT scanning, which found a clinically significant subdural hematoma.