cliot (version 1.0.0)

pecarn_head_injury_rule: PECARN Pediatric Head Injury/Trauma Algorithm

Description

Calculates the risk of clinically important Traumatic Brain Injury (ciTBI) in children with minor head trauma (GCS 14-15) using the PECARN prediction rules. The algorithm stratifies patients into Low, Intermediate, or High risk groups to guide the decision for head CT imaging versus observation. There are separate criteria for children < 2 years and those >= 2 years.

Usage

pecarn_head_injury_rule(age_years, gcs_score, altered_mental_status,
                        signs_of_skull_fracture, severe_mechanism_of_injury,
                        loc_duration_seconds = 0, not_acting_normally = 0,
                        non_frontal_scalp_hematoma = 0, history_of_vomiting = 0,
                        severe_headache = 0)

Value

A list containing:

Risk_Group

Classification (Low, Intermediate, High).

Risk_of_ciTBI

Estimated risk of clinically important TBI.

Recommendation

Guidance on CT imaging vs. observation.

Arguments

age_years

Numeric. Patient age in years. Determines which algorithm branch to use (<2 or >=2).

gcs_score

Numeric. Glasgow Coma Scale score.

altered_mental_status

Numeric (0 or 1). Agitation, somnolence, repetitive questioning, or slow response to verbal communication. (1 = Yes).

signs_of_skull_fracture

Numeric (0 or 1). Palpable fracture (if <2y) or signs of basilar skull fracture (if >=2y). (1 = Yes).

severe_mechanism_of_injury

Numeric (0 or 1). MVC with ejection/death/rollover, ped/bike vs auto, fall >3ft (<2y) or >5ft (>=2y), or head struck by high-impact object. (1 = Yes).

loc_duration_seconds

Numeric. Duration of loss of consciousness in seconds. (If > 0, counts as LOC history for >=2y. If > 5, counts as LOC criterion for <2y).

not_acting_normally

Numeric (0 or 1). [Only for < 2y] Is the child acting normally per parent? (1 = No/Not acting normally).

non_frontal_scalp_hematoma

Numeric (0 or 1). [Only for < 2y] Presence of non-frontal scalp hematoma. (1 = Yes).

history_of_vomiting

Numeric (0 or 1). [Only for >= 2y] History of vomiting. (1 = Yes).

severe_headache

Numeric (0 or 1). [Only for >= 2y] Severe headache. (1 = Yes).

References

Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160-1170. doi:10.1016/S0140-6736(09)61550-6

Examples

# Example 1: Child < 2 years, High Risk
# GCS 14, AMS
pecarn_head_injury_rule(1.5, 14, 1, 0, 0)

# Example 2: Child >= 2 years, Intermediate Risk
# 5yo, Vomiting, Normal GCS, No other signs
pecarn_head_injury_rule(5, 15, 0, 0, 0, history_of_vomiting = 1)

# Example 3: Child >= 2 years, Low Risk
# 8yo, No symptoms/signs
pecarn_head_injury_rule(8, 15, 0, 0, 0)