Pediatric Head Injury/trauma Algorithm to Reduce Computed Tomography, Overcrowding, Length of Stay in Emergency Department

Abstract

Abstract Background: Children with traumatic head injury are often carried from community to an Emergency Departments (ED) equipped with neurosurgery and pediatric medicine. The aims of this study is to evaluate the application of the PECARN TBI algorithm in the real life of our Emergency Department in all children who arrived for head trauma consecutively from 1 January 2016 to 31 December 2019 to decrease the number of head CT among pediatric patients. The secondary objective was to evaluate the impact of adhesion to this protocol on the crowding, length of stay and boarding time in the Emergency Department. Methods: We conducted a retrospective study of children aged ≤15 years who were managed in our ED for mild traumatic brain injury (TBI) from 1 January 2016 to 31 December 2019. Data collected included anamnesis, signs and symptoms, demographics, outcomes, times of the ED processes, main symptom complained, the causal factors, and the outcomes of pediatric TBI, in term of intracranial injuries (ICI) and injuries requiring neurosurgery (NSI). Results: A total of 1372 children with mild TBI were analyzed. The majority of patients were male (59.8%) and ≥ 2 years of age (63.2%). Most trauma (58%) caused by a home injury. Neurosurgical consultation (59.4%) was the most commonly interventions in the ED. Only 4.3% required neuroimaging and 7 children had hemorrhage, only 1 required immediate neurosurgical intervention. There were no re-entries for bleeding. The adoption of this protocol had no negative impact on crowding: protocol improve time processes. Conclusions: The adoption of the PECARNE algorithm allowed a low volume of brain CT scan with good clinical outcomes and did not increase crowding.