Paediatric head injuryPaediatric head injury

Dr Cynthia Lim

July 2012

3 big ones3 big ones

CATCHCHALICEPECARN

CATCH and CHALICE identify kids who need CTB

PECARN identify kids who don’t

CATCHCATCH

Multicentre cohort 3866 blunt head trauma 90% GCS 15 Derived decision rule based on high risk and medium

risk factors High risk factors 100% sensitive, 30% underwent

CTB Medium risk factors 98.1% sensitive, 52% underwent

CTB Not validated

CATCH inclusionCATCH inclusion

GCS 13-15LOCAmnesiaDisorientationPersistent vomitingIrritability

CATCH resultsCATCH results

GCS 13 – 2.5%GCS 14 – 7.3%

CTB found 4.1% brain injury0.6% neurological intervention

CHALICECHALICE

22 772 65% boys 56% under 5yrs 0.1% (281) abnormal CTB 0.006% (137) neurosurgical 15 died Derived rule with 98% sensitivity for clinically

significant head injury CTB rate of 14%

PECARNPECARN

Validated42 412Age under 2 years, age older than 2 yearsExcluded ground level falls35% CTB rateciTBIs 0.9% 0.1% neurosurgery

PECARN age under 2 yearsPECARN age under 2 years

Derivation pop 8502Validation pop 2216694 underwent CTB

NPV ciTBI 100%Sensitivity 100%

PECARN age under 2PECARN age under 2

Prediction rule– Normal mental status– No scalp haematoma (except frontal)– No LOC or LOC less than 5sec– Non severe mechanism– No palpable skull #– Acting normally acc to parents

PECARN age over 2PECARN age over 2

Derivation pop 25 283Validation pop 64112223 underwent CTB

NPV ciTBI 99.95%Sensitivity 96.8%

What about isolated vomiting?What about isolated vomiting?

2 out of 3 included vomitingCHALICE857 vomited more than 3 times (3.8%)56 of these children had a significant

brain injury on CT. 801 did not.6.5% risk serious brain injury if vomits

3 or more, but not isolated vomiters

Isolated vomitersIsolated vomiters

PECARN 1228 isolated vomiters Neurosurgical rate 0.1%