• Kentaro Ide, Satoko Uematsu, Shunsuke Hayano, Yusuke Hagiwara, Kenichi Tetsuhara, Tomoya Ito, Taichi Nakazawa, Ichiro Sekine, Masashi Mikami, and Tohru Kobayashi.
• Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan. Electronic address: ide-k@ncchd.go.jp.
• Am J Emerg Med. 2020 Aug 1; 38 (8): 1599-1603.

BackgroundHead trauma in children is one of the most common causes for emergency department visits. Although most trauma cases are minor, identifying those patients who have clinically important traumatic brain injury (ciTBI) is challenging. The Pediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rules identifying children who do not require cranial computed tomography (CT) were validated and are used all over the world. However, these rules have not been validated with large cohort multicenter studies in Asia.ObjectivesTo investigate whether the PECARN rules can be safely applied to Japanese children.MethodsWe conducted a multicenter, prospective, observational cohort study. We included children younger than 16 with minor head trauma (Glasgow Coma Scale ≥14) who presented to the six participating centers within 24 h of their injuries between June 2016 and September 2017. The primary analysis was set to calculate the negative predictive value of the patients with very low risk by the PECARN rules, compared with a preset threshold of 99.85%.ResultsWe included 6585 children of which 463 (7.0%) had head CT scans performed and 23 (0.35%) had ciTBI. There were two patients with ciTBI who were classified as very low risk. The negative predictive value, calculated as 99.96% (95%CI: 99.86-100.00; P = .019), was significantly superior compared with the preset threshold of 99.85%.ConclusionsThe PECARN head trauma prediction rules seemed to be safely applicable to Japanese children. Further studies are needed to determine safety in hospitals where physicians do not have expertise in managing children.Copyright © 2019 Elsevier Inc. All rights reserved.

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