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Objectives The Pediatric Emergency Care Applied Research Network ( PECARN) head trauma prediction rules are used to assist computed tomography ( CT) decision-making for children with minor head trauma. Although the PECARN rules have been validated in North America and Europe, they have not yet been validated in Asia. In Japan, there are no clinical decision rules for children with minor head trauma. The rate of head CT for children with minor head trauma in Japan is high since CT is widely accessible across the country. The objective of this study was to evaluate the diagnostic accuracy of the PECARN rules for identifying clinically important traumatic brain injuries (ci TBI) in children with minor head trauma in Japan. Methods We conducted a retrospective cohort study at a tertiary care pediatric hospital in Japan (30,000 patients/year). We enrolled all children younger than 18 years with minor head trauma (Glasgow Coma Scale ≥ 14) who presented to the emergency department within 24 hours of their injury between January and December 2013. We retrospectively classified the children into three risk categories according to the PECARN rules. The PECARN rules were considered negative when children were classified into the very-low-risk category. The primary outcome was considered positive when a child had ci TBI defined as head injury resulting in death, neurosurgery, intubation for > 24 hours, or hospital admission ≥ 2 nights with evidence of TBI on CT. Results Among 2,208 children included in the study, 24 (1.1%) had ci TBI. Sensitivities and specificities of the PECARN rules to predict ci TBI were 85.7% (12/14; 95% confidence interval [ CI] = 57.2 to 98.2) and 73.5% (572/778; 95% CI = 70.3 to 76.6), respectively, for children < 2 years old, and 100% (10/10; 95% CI = 58.7 to 100) and 73.5% (1033/1406; 95% CI = 71.0 to 75.7) for children ≥ 2 years old, respectively. There were 10 cases of physically abused children < 2 years old, and six (60%) of them had ci TBI. Also, two cases of physically abused children with ci TBI were classified as very low risk. If we did not include physically abused children, the sensitivity of the PECARN rule for children < 2 years old improved from 85.7% to 100% (8/8). Conclusions The PECARN rules were less sensitive for physically abused children, although the rules showed excellent applicability for the cohort without physical abuse. Thoughtful consideration may be needed for cases of nonaccidental trauma. Further prospective studies are required to verify the applicability of the PECARN rules for children with minor head trauma in Japan. [ABSTRACT FROM AUTHOR]

Terrestrial radon-222 flux density for the Asian continent, integrated over distances of 4500 km, is estimated in two 20° latitudinal bands centred on 48.8°N and 63.2°N. The evaluation is based on three years of wintertime radon measurements at Sado Island, Japan, together with meteorological and trajectory information. A selection of 18% of observations are suitable for evaluation of an analytical expression for the continental surface flux. Various meteorological assumptions are discussed; it is found that there is a substantial effect of increased complexity of the formulation on the flux estimates obtained. The distribution of spatially integrated radon flux over the Asian landmass is reported for the first time. Expressed as geometric means and 1σ-ranges, estimated fluxes are 14.1 mBq m−2 s−1 (1σ-range: 18 mBq m−2 s−1) and 8.4 mBq m−2 s−1 (1σ-range: 10 mBq m−2 s−1) for the lower and higher latitude bands. These results constitute an annual minimum in flux densities for these regions, and are higher than previously reported. The existence of a latitudinal gradient in the continental radon source function is confirmed; the present estimate for Asia (−0.39 mBq m−2 s−1 per degree of latitude) is in agreement with the northern hemisphere terrestrial radon flux gradient proposed previously. [ABSTRACT FROM AUTHOR]