title: Applicability of the CATCH, CHALICE and PECARN paediatric head injury clinical decision rules: pilot data from a single Australian centre.
abstract: BACKGROUND
  Clinical decision rules (CDRs) for paediatric head injury (HI) exist to identify children at risk of traumatic brain injury. Those of the highest quality are the Canadian assessment of tomography for childhood head injury (CATCH), Children's head injury algorithm for the prediction of important clinical events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs. They target different cohorts of children with HI and have not been compared in the same setting. We set out to quantify the proportion of children with HI to which each CDR was applicable.
  
  
  METHODS
  Consecutive children presenting to an Australian paediatric Emergency Department with HIs were enrolled. Published inclusion/exclusion criteria and predictor variables from the CDRs were collected prospectively. Using these we determined the frequency with which each CDR was applicable.
  
  
  RESULTS
  1012 patients (69.9%) were enrolled with 949 available for analysis. Mean age was 6.8 years (21% <2 years). 95% had initial Glasgow Coma Scale 15. CT rate was 12.8% and neurosurgery rate was 0.7%. No CDR was applicable to all patients. CHALICE was applicable to the most (97%, 95% CI 96% to 98%) and CATCH to the fewest (26%, 95% CI 24% to 29%). PECARN was applicable to 76% (95% CI 70% to 82%) aged <2 years, and 74% (95% CI 71% to 77%) aged 2-<18 years.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Lyttle
authors.forename: John A
authors.initials: JA
authors.lastname: Cheek
authors.forename: Carol
authors.initials: C
authors.lastname: Blackburn
authors.forename: Ed
authors.initials: E
authors.lastname: Oakley
authors.forename: Brenton
authors.initials: B
authors.lastname: Ward
authors.forename: Amanda
authors.initials: A
authors.lastname: Fry
authors.forename: Kim
authors.initials: K
authors.lastname: Jachno
authors.forename: Franz E
authors.initials: FE
authors.lastname: Babl
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed