Applicability of the CATCH, CHALICE and PECARN paediatric head injury clinical decision rules: pilot data from a single Australian centre

Abstract

Each CDR is applicable to a different proportion of children with HI. This makes a direct comparison of the CDRs difficult. Prior to selection of any for implementation they should undergo validation outside the derivation setting coupled with an analysis of their performance accuracy, usability and cost effectiveness.

A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST)

“…These centres are members of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) [23]: in New Zealand Kidz First Children’s Hospital, Auckland, and Starship Children’s Hospital, Auckland; in Australia Monash Medical Centre, Clayton, VIC, Children’s Hospital at Westmead, Sydney, NSW, Royal Children’s Hospital, Melbourne, VIC, Royal Children’s Hospital, Brisbane, QLD, Mater Children’s Hospital, Brisbane, QLD, Princess Margaret Hospital for Children, Perth, WA, Women’s & Children’s Hospital, Adelaide, SA, and Townsville Hospital, Townsville, QLD. The annual paediatric census of the 10 participating EDs is >400,000.…”

“…All study materials have been piloted at a single site (Royal Children’s Hospital Melbourne) [23]; modification of the materials to comply with local patient flow and administrative requirements have been assessed and approved by the study steering committee.…”

Use of sedation in children receiving computed tomography after head injuries

“…Consent was waived. This study was part of an existing prospective head injury study, the Australasian Pediatric Head Injury Study (APHIRST) [16], which identifies children with head injuries of all severities, and seeks to validate three highquality head injury clinical decision rules for CTB use in children in an Australian population. Management of head injuries was on the basis of published hospital guidelines [16].…”

“…Although this is obvious for patients intubated prehospital (n = 19), there were 14 patients who were intubated in ED before their CTB. Although the indication for the intubation may have included sedation for CTB, nine had an initial GCS of 8 or less and were intubated as recommended in hospital and international guidelines [16,22]. Another had a GCS of 11 and was intubated for respiratory compromise.…”

Physician practice and PECARN rule outperform CATCH and CHALICE rules based on the detection of traumatic brain injury as defined by PECARN

“…CHALICE applies to a broad population of head injuries of any severity, PECARN was developed for minor head injuries only and CATCH focused on a group of patients with specific signs or symptoms. A strict application of the inclusion criteria for CATCH in particular narrows the applicability of the CDR to only about a quarter of emergency department head injury presentations as presented in web appendix E4 and shown elsewhere 6. Similarly, CHALICE was developed for children under 16 years.…”