Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study

Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its...

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Autores principales:	Naoki Yogo, Chiaki Toida, Takashi Muguruma, Masayasu Gakumazawa, Mafumi Shinohara, Ichiro Takeuchi
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	pediatrics emergency department clinically important traumatic brain injury Medicine R
Acceso en línea:	https://doaj.org/article/6f6bdfe6fed34471ae6d1ce353416990
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spelling	oai:doaj.org-article:6f6bdfe6fed34471ae6d1ce3534169902021-11-25T18:00:51ZSimplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study10.3390/jcm102252482077-0383https://doaj.org/article/6f6bdfe6fed34471ae6d1ce3534169902021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5248https://doaj.org/toc/2077-0383Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; <i>p</i> = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.Naoki YogoChiaki ToidaTakashi MugurumaMasayasu GakumazawaMafumi ShinoharaIchiro TakeuchiMDPI AGarticlepediatricsemergency departmentclinically important traumatic brain injuryMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5248, p 5248 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pediatrics emergency department clinically important traumatic brain injury Medicine R
spellingShingle	pediatrics emergency department clinically important traumatic brain injury Medicine R Naoki Yogo Chiaki Toida Takashi Muguruma Masayasu Gakumazawa Mafumi Shinohara Ichiro Takeuchi Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study
description	Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; <i>p</i> = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.
format	article
author	Naoki Yogo Chiaki Toida Takashi Muguruma Masayasu Gakumazawa Mafumi Shinohara Ichiro Takeuchi
author_facet	Naoki Yogo Chiaki Toida Takashi Muguruma Masayasu Gakumazawa Mafumi Shinohara Ichiro Takeuchi
author_sort	Naoki Yogo
title	Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study
title_short	Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study
title_full	Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study
title_fullStr	Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study
title_full_unstemmed	Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study
title_sort	simplified clinical decision rule using clinically important events for risk prediction in pediatric head injury: a retrospective cohort study
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/6f6bdfe6fed34471ae6d1ce353416990
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Simplified Clinical Decision Rule Using Clinically Important Events for Risk Prediction in Pediatric Head Injury: A Retrospective Cohort Study

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