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Duel of the Rules: Which decision rule for head injury in children?

While we all like to feel that our razor sharp clinical acumen is sufficient to pick out the badness, it is nice to have some evidence based back up for our hunches and ‘gut feelings’. So in order to help guide us through choppy diagnostic waters, a great deal of time and effort has been expended to develop clinical decision rules (CDR’s) (or instruments, if you prefer). For chest pain we have TIMI, PERC, HEART to name just a few. Unsurprisingly, paediatric head injuries also have a selection of decision rules to choose from. Of course, this brings with it yet another question; which rule to use? Which is best? This is the question the authors of this study have tried to answer. They have taken…

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Featured

 Head injury – who to scan?

The trouble with CHALICE – highly sensitive but not specific. A recent Australian study found implementation of CHALICE may potentially more than double CT rate. With only a very small increase in detection of CT abnormalities. And none of those requiring intervention.

Articles of Interest

Comparison of CATCH, PECARN, and CHALICE clinical decision rules in pediatric patients with mild head trauma

The present study found that the PECARN and CATCH rules in children with minor head injury were significantly sensitive in detecting CT positivity and the need for hospitalization.

Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children

The CHALICE rule, derived from 22 772 children attending the emergency departments of 10 hospitals in the UK, may provide a comprehensive clinical decision rule for the management of head injuries in children that identifies patients at risk of significant intracranial pathology.

The CHALICE rule: ready for prime time?

The paper by Dunning et al1 in this issue discusses a classic medical screening problem. Particularly during the long, light summer evenings, every accident and emergency department in the country sees large numbers of children who have sustained traumatic head injuries, most of which seem trivial; but among such children, there are a small number who are at avoidable risk of severe disability or death. How can they be identified most effectively?

Resources

Radiopaedia

The Children’s Head injury ALgorithm for prediction of Clinically Important Events (CHALICE) clinical decision rule was developed to predict clinically important brain injuries in children with head trauma. This rule identifies high-risk criteria and divides them into history, examination and mechanism.