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

Objective: In this study, we aimed to evaluate the diagnostic accuracy of the Pediatric Emergency Care Applied Research Network (PECARN), Canadian Assessment of Tomography for Childhood Head Injury (CATCH), and children’s head injury algorithm for the prediction of important clinical events guidelines in identifying clinically important traumatic brain injury (ciTBI) in pediatric patients with minor head injury.
Material and Methods: This single-center, prospectively designed study was performed in the emergency department (ED) of a tertiary hospital. The study included patients under 18 years old who presented to the ED with head trauma and a GCS of 14-15. The primary outcome of the study was the relationship between the decision rules and ciTBI.
Results: The study was completed with 502 patients. It was found that the PECARN algorithm was 80% sensitive in detecting ciTBI in patients younger than 2 years of age, and 84.55% in patients aged 2 years or older. While this rate decreased (50.0%) in CATCH, it was higher (89.54%) in CHALICE. In the detection of patients without a risk (specificity), all 3 algorithms found good detections, and the specificity rates were between 82% and 90%.
Conclusion: 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.

Keywords: Pediatrics, emergency department, clinically important traumatic brain injury