Article Text

other Versions

PDF
Comparing CATCH, CHALICE and PECARN clinical decision rules for paediatric head injuries
  1. Mark D Lyttle1,
  2. Louise Crowe2,
  3. Ed Oakley2,3,
  4. Joel Dunning4,
  5. Franz E Babl1,2,5
  1. 1Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  2. 2Murdoch Children's Research Institute, Melbourne, Australia
  3. 3Emergency Department, Monash Medical Centre, Clayton, Australia
  4. 4James Cook University Hospital, Middlesbrough, UK
  5. 5The University of Melbourne, Melbourne, Australia
  1. Correspondence to Dr M D Lyttle, Emergency Department, Bristol Royal Hospital for Children, Bristol, UK; mark.lyttle{at}uhbristol.nhs.uk

Abstract

Many children present to emergency departments following head injury (HI), with a small number at risk of avoidable poor outcome. Difficulty identifying such children, coupled with increased availability of cranial CT, has led to variation in practice and increased CT rates. Clinical decision rules (CDRs) have been derived for paediatric HI but there is no published comparison to assist in deciding which to implement. The content of the three of highest quality and accuracy are described and compared. Systematic reviews of paediatric HI CDRs were published in 2009 and 2011. To identify CDRs published since the most recent review, key databases were searched, selecting studies which included CDRs involving children aged 0–18 years with a history of HI. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies Tool, and performance evaluated by reported accuracy. Three high quality CDRs were identified: CATCH (Canadian Assessment of Tomography for Childhood Head Injury) CHALICE (Children's Head Injury Algorithm for the Prediction of Important Clinical Events) and PECARN (Paediatric Emergency Care Applied Research Network). All were derived with high methodological standards but differed in key areas, including study population, outcomes and severity of HI. Each stated different predictor variables and only PECARN provided a separate algorithm for young children. CATCH and CHALICE identify children requiring CT and PECARN those who do not. All perform with high sensitivity and low specificity. PECARN is the only validated CDR, and none has undergone impact analysis. These three CDRs should undergo validation and comparison in a single population, with analysis of their impact on practice and financial implications, to aid relevant bodies in deciding which to implement.

Statistics from Altmetric.com

Footnotes

  • Funding The study was supported in part by grant funding from the Murdoch Children's Research Institute (MCRI), Melbourne, Australia. MCRI is a non-governmental paediatric research institute. There was no influence on the part of the funder on the design or conduct of the study.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.