Impact of a Triage-Based Blunt Trauma Assessment on PECARN Recommendations and Neuroimaging Use in Pediatric Head Injury

This study aimed to evaluate the impact of a triage-based blunt trauma assessment (best practice advisory) on Pediatric Emergency Care Applied Research Network (PECARN)-guided recommendations and actual head computed tomography (CT) use in children <18 years old presenting with head injury. We examined agreement between best practice advisory recommendations, PECARN risk categories, and head CT use, as well as risk factors associated with deviation from PECARN guidance. Group comparisons were analyzed by Mann-Whitney rank-sum test, Kruskal-Wallis test, Fisher exact test, or χ² test, as indicated. Best practice advisory and PECARN agreement was 47%. The best practice advisory aligned with CT use in 39% of cases, whereas PECARN aligned 73%. In children <2 years, 42% received a head CT despite a PECARN recommendation against it (<i>P</i> < .001). In children ≥2 years, 38% received a head CT against PECARN recommendations (<i>P</i> < .001). Overall agreement among best practice advisory, PECARN, and head CT use was 35%. Symptoms such as speech changes, lethargy, altered mood, and gait abnormalities were associated with deviations from PECARN. Findings suggest that although PECARN guides imaging decisions, numerous clinical factors and best practice advisory recommendations influence provider behavior, highlighting opportunities to improve decision support and reduce unnecessary CT scans.