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Does the CATCH clinical decision rule adequately determine which children with minor head injury require computed tomography (CT) imaging?

This validation study of the CATCH clinical decision rule for pediatric minor head injury failed to provide a sensitivity as high as its derivation study. The results make CATCH inadequate to be safely applied in the emergency department. Consequently, the authors used recursive partitioning to derive the CATCH-2 clinical decision rule by removing “high risk” and “medium risk” stratification and instead adding an eighth criterion of “vomiting ≥ 4 episodes.” These changes provided 100% sensitivity for neurosurgical intervention. Although CATCH-2 shows promise, it has not yet been prospectively validated, a requisite step prior to clinical implementation.

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  CATCH (Canadian Assessment of Tomography for Childhood Head injury) Rule

Quick assessment

  CATCH2 rule

CT of the head is required for children with minor head injury and any 1 of these findings: • GCS score < 15 at 2 hours after injury • Suspected open or depressed skull fracture • History of worsening headache • Irritability on examination • Any sign of basal skull fracture • Large, boggy hematoma of the scalp • Dangerous mechanism of injury • ≥ 4 episodes of vomiting

Articles of Interest

Tiny Tips: The CATCH Rule

The CATCH rule is a Canadian minor head injury clinical decision rule that has been prospectively derived...

Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department

Among children presenting to the emergency department with the signs and symptoms of acute minor head injury, the CATCH2 rule was highly sensitive for identifying those children requiring neurosurgical intervention and those with any brain injury on CT. The CATCH2 rule should be further validated in an implementation study designed to assess its clinical impact.

CATCH rules accurately predict which kids need head CT

The decision rule for head CT consisted of four high-risk factors, including failure to reach a score of 15 on the Glasgow coma scale within two hours, suspicion of open skull fracture, worsening headache, and irritability. Three additional medium-risk factors (large, boggy hematoma of the scalp; signs of basal skull fracture; and dangerous mechanism of injury) were also included in the decision rule.

CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury

The CATCH rule is a sensitive, prospectively derived clinical decision rule that has the potential to both standardize the need for CT and reduce the number of CT scans performed for children with minor head injury.

Evaluation of Three Clinical Decision Rules in Pediatric Patients with Minor Head Injury: PECARN, CHALICE and CATCH

ciTBI risk prediction models will assist in clinical decision making and establish an accurate neuroimaging strategy. According to the results of our study, all three clinical decision rules can be safely used in the management of pediatric minor head trauma patients.

Review of the CATCH study: a clinical decision rule for the use of computed tomography in children with minor head injury

Prior to the CATCH study, numerous studies have attempted to derive a CDR for pediatric minor head injury.15–20 A recent study by the Pediatric Emergency Care Applied Research Network (PECARN) in the United States derived and validated a CDR for children with minor head injuries. This study was similar to the CATCH study in study design and inclusion criteria, but the PECARN study analyzed children under 2 years of age separately from those aged 2 to 16 years.

The comparison of PECARN, CATCH, AND CHALICE criteria in children under the age of 18 years with minor head trauma in emergency department

Given the populations to which the rules apply, it is understood that the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events criteria is more determinative in detecting pathological computed tomography outcomes compared to Pediatric Emergency Care Applied Research Network and Canadian Assessment of Tomography for Childhood Head Injury.

To CT or Not to CT – PECARN, CHALICE, and CATCH Algorithms

In this 16-minute lecture from Rebellion in EM 2021, Dr. Hilary Fairbrother focuses on the description of PECARN, CHALICE, and CATCH algorithms with best practices for use in pediatric patients with head trauma.

Resources

CATCH Rule

Predicts clinically significant head injuries in children. Less sensitive than the PECARN Algorithm.