268 Comparing Pediatric Head CT Rules Using Outcomes for Acute Lifesaving Intervention

Abstract

Rates of pediatric head CT for mild blunt head trauma (BHT) have not shown improvement while published clinical prediction rules (CDRs) have been available. Outcomes for these CDRs may be too inclusive and set the threshold to scan unreasonably low. We sought to compare the sensitivity of five published CDRs in detecting outcomes limited to the need for acute lifesaving intervention. We conducted a retrospective chart review of patients <18 years old presenting to the ED between the years 2006 through 2013 at a single academic Level 1 Pediatric Trauma Center with diagnoses consistent with intracranial injury and who received head CT as part of their management. Patients meeting criteria for mild non-penetrating BHT (GCS 14-15) were screened for the following outcomes indicating a need for acute lifesaving intervention: neurosurgical procedure, intubation due to head injury, and death. The five following CDRs were then assessed for their ability to detect patients with these outcomes: the Pediatric Emergency Care Applied Research Network (PECARN) CT head rule, the Canadian Assessment of Tomography for Childhood Head injury 2 (CATCH2) rule, the Children’s Head injury ALgorithm for prediction of Clinically Important Events (CHALICE), the Pediatric National Emergency X-Radiography Utilization Study II (NEXUS II) Head CT Decision Instrument, and the decision rule developed by Palchak et al. Out of 1,810 patients with diagnosis codes consistent with intracranial injury and that received CT, 1,162 met the criteria for mild non-penetrating BHT and were screened for the outcomes of interest. 21 patients had one or more of the three outcomes, representing 1.8% of those screened. The average age was 4.6 years and the majority (62%) were male. All 21 patients required intubation due to their head injury with 9 receiving a neurosurgical procedure (0.8%) and no deaths. All CDRs displayed 100% sensitivity with each patient meeting at least 1 criterion for each CDR. All CDRs displayed 100% sensitivity at detecting outcomes indicating a need for acute lifesaving intervention in pediatric mild BHT. Future prospective studies should consider similar outcomes to assess their utility in decreasing unnecessary pediatric head CT.