Abstract
Computed tomography (CT) scans are useful for confirming head injury diagnoses. However, there is no standard clinical decision rule (CDR) for determining the need for CT scanning in pediatric patients with head injuries. We developed a CDR and conducted a retrospective cohort study to evaluate its diagnostic accuracy in identifying children with clinically important traumatic brain injury (ciTBI). We selected predictors based on three existing CDRs: CATCH, CHALICE, and PECARN. Of the 2569 eligible patients, 645 (439 (68%) boys, median age: five years) were included in this study. In total, 59 (9%) patients showed ciTBI, and 129 (20%) were admitted to hospital. The novel CDR comprised six predictors of abnormal CT findings. It had a sensitivity of 79.5% (95% confidence interval (CI): 65.5–89.0%) and a specificity of 50.9% (95% CI: 48.9–52.3%). The area under the receiver-operating characteristic curve (0.72, 95% CI: 0.67–0.77) was non-inferior to those of CATCH, CHALICE, and PECARN (0.71, 95% CI: 0.66–0.77; 0.67, 95% CI: 0.61–0.74; and 0.69, 95% CI: 0.64–0.73, respectively; p = 0.57). The novel CDR was statistically noninferior in diagnostic accuracy compared to the three existing CDRs. Further development and validation studies are needed before clinical application.
Highlights
Pediatric head injuries, which are mostly of mild severity, are a frequent cause of visits to the emergency department (ED)
We developed a clinical decision rule (CDR) in this study, wherein predictors were selected from potential predictor variables based on the existing literature; if the variables were determined to be statistically significant in the univariate logistic regression analysis, they were included in the multivariable analysis
Area under the curve (AUC) values for the four rules including the simplified CDR that we developed in this study, Canadian Assessment of Tomography for Childhood HeadInjury (CATCH), CHALICE, and Pediatric Emergency Care Applied Research Network (PECARN)
Summary
Pediatric head injuries, which are mostly of mild severity, are a frequent cause of visits to the emergency department (ED). Radiation exposure from CT scans might result in lethal malignancies [2,3]; it is important to consider the need for CT scans in pediatric patients with head injuries [4,5,6,7,8,9,10,11]. There are three clinical decision rules (CDRs) that have been formulated to prevent a missed diagnosis of serious or clinically important traumatic brain injuries (ciTBI) and to avoid unnecessary CT scans: the Canadian Assessment of Tomography for Childhood Head. CATCH predicts the need for a CT scan and stratifies a high risk for neurological intervention and a medium risk for possible brain injury on CT. CHALICE is a rule that predicts a low risk of intracranial pathology if none of the variables are present
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