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Comparison of CATCH, PECARN, and CHALICE clinical decision rules in pediatric patients with mild head trauma
Gizem Meral Atiş1, Tamer Altay1, Şeref Emre Atiş2
1Department of Neurosurgery, Prof. Dr. Cemil Taşcıoğlu Training and Research Hospital, Istanbul, Turkey.
Insights
The PECARN and CATCH clinical decision rules are effective for identifying children with minor head injuries who need a head CT scan or hospitalization. The CHALICE protocol was not found to be statistically significant in these evaluations.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support
- Trauma Care
Background:
- Blunt head trauma is common in children.
- Clinical decision rules (CDRs) aid in managing pediatric head injuries.
- Evaluating the effectiveness of CDRs like PECARN, CATCH, and CHALICE is crucial for optimizing patient care.
Purpose of the Study:
- To compare the effectiveness of the CATCH, PECARN, and CHALICE clinical decision protocols for pediatric blunt head trauma.
- To evaluate these protocols from a population perspective in identifying patients requiring head CT and hospitalization.
Main Methods:
- A study included pediatric patients (<18 years) with blunt head trauma and Glasgow Coma Scale score ≥13, who underwent head CT.
- The PECARN, CATCH, and CHALICE clinical decision rules were applied retrospectively.
- Data were compared against head CT results and the need for hospitalization.
Main Results:
- PECARN showed 82.76% sensitivity and 45.03% specificity for CT positivity; CATCH showed 89.29% sensitivity and 47.44% specificity, both statistically significant.
- For hospitalization, PECARN had 83.87% sensitivity and 45.12% specificity; CATCH had 90% sensitivity and 47.54% specificity, both statistically significant.
- CHALICE did not demonstrate statistical significance in detecting CT positivity or the need for hospitalization.
Conclusions:
- PECARN and CATCH protocols are significantly sensitive in identifying children with minor head injuries who require head CT.
- Both PECARN and CATCH effectively identified the need for hospitalization in pediatric patients with head trauma.
- The CHALICE protocol was found to be less effective compared to PECARN and CATCH in this pediatric population.
Purpose:
The present study compares the most frequently used the CATCH, PECARN, and CHALICE clinical decision protocols with an aim to evaluate their effectiveness from the population perspective.
Methods:
This study included all patients under 18 years of age presenting with blunt head trauma and a Glasgow Coma Scale score of 13 and higher for whom the attending physician decided to order head computed tomography scans, and the legal representative provided an informed consent for inclusion in the study. The PECARN, CATCH, and CHALICE clinical decision rules were applied to the participating patients, and the data for each of the three international clinical decision rules were recorded. These data were then compared to head CT results.
Results:
Based on the head CT positivity, the sensitivity and specificity values for the PECARN were 82.76 and 45.03%; the sensitivity and specificity values for CATCH were 89.29 and 47.44%, showing statistical significance in predicting CT positivity; the CHALICE did not show statistical significance in detecting a pathological CT result. In terms of evaluating the need for hospitalization, the PECARN had a sensitivity of 83.87% and a specificity of 45.12%; the CATCH had a sensitivity of 90% and a specificity of 47.54%, showing statistical significance while the CHALICE did not significantly detect the need for hospitalization.
Conclusions:
The present study found that the PECARN and CATCH rules in children with minor head injury were significantly sensitive in detecting CT positivity and the need for hospitalization.
