경증 두부외상을 가진 소아환자의 뇌 전산화단층시행 감소를 위한 PECARN rule 교육의 효과
The effect of introducing Pediatric Emergency Care Applied Research Network (PECARN) rule on reducing brain computed tomography use for children with minor head injury
정성운, 장재호, 조진성, 현성열, 임용수, 양혁준, 최재연,
소속 상세정보
정성운 ( Jung Sung-Wun )
가천대학교 의과대학 길병원 응급의학교실
장재호 ( Jang Jae-Ho )
가천대학교 의과대학 길병원 응급의학교실
조진성 ( Cho Jin-Seong )
가천대학교 의과대학 길병원 응급의학교실
현성열 ( Hyun Sung-Youl )
가천대학교 의과대학 길병원 외상외과교실
임용수 ( Lim Yong-Su )
가천대학교 의과대학 길병원 응급의학교실
양혁준 ( Yang Hyuk-Jun )
가천대학교 의과대학 길병원 응급의학교실
최재연 ( Choi Jae-Yeon )
가천대학교 의과대학 길병원 응급의학교실
Abstract
Purpose: Computed tomography (CT) scan is an effective modality for detecting fatal traumatic brain injury. However, radiation exposure from CT can increase the risk of cancer, and children are more vulnerable to radiation than adults. We aimed to investigate the effect of introducing the Pediatric Emergency Care Applied Research Network (PECARN) rule to the emergency department (ED).
Methods: Medical records of children younger than 2 years with minor head injury who visited ED from January 2013 to June 2015 were reviewed. We started the education of radiation hazard and the PECARN rule in January 2014. The children were divided into pre- and post- education groups. The baseline characteristics, CT rate, and clinical outcomes were analyzed. The safety and efficacy of CT were defined as patients who received head CT scan per those experiencing clinically important traumatic brain injury (ciTBI) and patients without CT scan per those without ciTBI, respectively.
Results: Of 911 patients, 360 (39.5%) visited during the post-education period. Median age was 16.0 months (interquartile range, 11.0-20.0 months), and boys accounted for 58.5%. CT rate was reduced from 40.5% to 12.8% (P < 0.001). There was no difference in ciTBI rates between the two groups (1.3% vs. 1.7%, P = 0.622). The safety was 100% in both periods and the efficacy increased from 52.9% to 88.7%.
Conclusion: We have seen a significant decrease in CT rate through the education of the PECARN rule. After its introduction, CT use was reduced, and the efficacy was improved without decrease in the safety.
키워드
Brain Injuries; Craniocerebral Trauma; Pediatrics; Radiation; Tomography, X-Ray Computed
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