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Chapter 4

EEM 2019: Pediatric Head Injury with Dr. PECARN

Salim Rezaie, MD, Nate Kupperman, MD, and Rob Orman, MD
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25:20
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The PECARN Pediatric Head Injury/Trauma Algorithm can reduce our use of CTs in peds patients, but it’s often misunderstood (or not even used in the first place). From Essentials of EM 2019, PECARN lead investigator, Nate Kupperman, breaks down how he uses the pathway, limitations, and common misunderstandings. As a bonus, the talk is preceded by REBEL EM’s Salim Rezaie setting the stage with a breakdown of the primary literature.

 

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Roee S. -

Hi there- thanks for everything you do Rob, big fan.
Im an emergency medicine resident in Israel. Ive already had a couple of cases in patients with PECARNs of 0 but with multiple episodes of vomiting. They inevitably get scanned, and from the few cases Ive had, the scans have been negative. My question is this- does multiple episodes of vomiting in a patient with a PECARN of zero change your approach? Do you ignore the vomiting, as it is not included in the PECARN criteria?

Thanks
Roee

Rob O., MD -

Hey Roee! I'm guessing you are talking about the kids under 2 years old (since vomiting is one of the PECARN elements in kids over 2). Asking specifically about the under 2s, we sent your question to Nate Kupperman and here's what he has to say...

I am conscious of vomiting in this age group, although not one of the rule factors. I would observe the child for 4 hours and if coming persists, I would scan
But to be clear, number of vomits prior to presentation not significant in either age group.
For the older group, a history of any vomiting is a factor (i.e. the software did not identify a “high risk number of vomits”)
For the younger age group, history of vomiting is not a PECARN risk factor

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2.25 AMA PRA Category 1 Credits™ certified by Hippo Education (2019)