Application of the CHALICE clinical prediction rule for intracranial injury in children outside the UK: impact on head CT rate.
OBJECTIVE
The children's head injury algorithm for the prediction of important clinical events (CHALICE) is one of the strongest clinical prediction rules for the management of children with head injuries. The authors set out to determine the impact of this rule on the proportion of head injured patients receiving a CT scan in a major Australian paediatric emergency department.


METHODS
Retrospective cohort study.


METHODS
Tertiary paediatric hospital emergency department in Australia (67 000 patients/year).


METHODS
All head injured patients presenting to the emergency department in 2004.


METHODS
Actual proportion of head injured patients receiving a CT scan compared with the proportion had the CHALICE algorithm been applied.


RESULTS
There were 1091 head injuries of all severities during the study period. 18% of head injured patients had a Glasgow Coma Scale <15, 19% a CT scan and 1.4% neurosurgical intervention. Application of the CHALICE algorithm would result in 46% receiving a CT scan. 303 patients who fit CHALICE criteria did not have a CT scan. These patients were managed with admission for observation or discharge and head injury instructions. Only five of these (1.6% or 0.5% of total head injuries) received a CT scan on representation for ongoing symptoms, four of which showed abnormalities on CT scan.


CONCLUSIONS
Application of the CHALICE rule to this non-UK dataset would double the proportion of CT scans, with an apparent small gain in delayed pick-up of CT abnormalities. The role of expectant observation in hospital or at home needs to be defined.
Crowe
Louise
L
University of Melbourne, Melbourne, Australia. louise.crowe@mcri.edu.au
Anderson
Vicki
V
Babl
Franz E
FE
D000293:Adolescent; D000465:Algorithms; D001930:Brain Injuries / Q000000981:diagnostic imaging*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D014739:Victoria