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Updated: Jul 7, 2026
Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
Published on: August 16, 2019
Comparison of predictive tools for management of paediatric mild TBI: a prospective cohort study
Fredrik Wickbom1,2, Sarah Thornberg3, Jorge Sotoca Fernandez4
1Department of Clinical Sciences, Malmö, Lund University Faculty of Medicine, Lund, Sweden.
Insights
This study compared pediatric traumatic brain injury (TBI) guidelines, finding SNC16 offered the highest sensitivity for significant CT findings. Guidelines varied in applicability, with CATCH/CATCH2 applying to fewer children than others.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Rules
- Neurotrauma Research
Background:
- Multiple clinical practice guidelines and decision rules exist for emergency department (ED) triage of children with traumatic brain injury (TBI).
- These guidelines vary in structure, aim, target cohort, and outcomes, despite being used in similar pediatric populations.
- A comprehensive comparison of these guidelines within a real-world pediatric TBI cohort was needed.
Purpose of the Study:
- To compare the clinical and practical characteristics of major pediatric traumatic brain injury (TBI) guidelines.
- To assess the diagnostic accuracy and applicability of various TBI decision rules in a large, real-world cohort.
- To evaluate the impact of different guidelines on cranial computed tomography (cCT) utilization and clinical outcomes.
Main Methods:
- A prospective, pragmatic, observational study was conducted in 16 EDs in Sweden and Norway.
- Children (<18 years) with mild-moderate TBI were enrolled between April 2018 and May 2024.
- Diagnostic accuracy and characteristics of CATCH, CATCH2, CHALICE, PECARN, SNC16, PREDICT, and NICE23 were assessed for significant cCT findings, neurosurgical interventions, and guideline-specific endpoints.
Main Results:
- The cohort included 3012 children; 0.9% had significant cCT findings, and 0.07% required neurosurgery.
- Guideline applicability varied: CATCH/CATCH2 applied to 31.0%, while others applied to >94% of patients.
- SNC16 demonstrated the highest sensitivity (100%) for significant cCT findings, while CHALICE had the highest specificity (78.3%). Mandatory cCT rates ranged from 1.2% (PREDICT) to 29.9% (CATCH2).
Conclusions:
- Head-to-head comparison of pediatric TBI guidelines in a real-world cohort provides crucial insights.
- Significant variations exist in diagnostic accuracy, sensitivity, specificity, and practical applicability among TBI decision rules.
- Findings aid in understanding the comparative performance of guidelines, informing clinical practice and guideline development for pediatric TBI triage.
Background:
Multiple clinical practice guidelines and head computed tomography decision rules exist for emergency department (ED) triage of children with traumatic brain injury (TBI). These vary in structure, aim, target cohort, and outcomes, yet are used clinically in similar populations. We compared important clinical and practical characteristics of all major guidelines in a large, real-world paediatric traumatic brain injury (TBI) cohort.
Methods:
Prospective, pragmatic, observational study of children (<18 years of age) presenting with mild-moderate TBI to 16 EDs in Sweden and Norway, including prospective documentation of guideline-specific risk factors and outcomes between April 2018 and May 2024. We assessed the diagnostic accuracy and characteristics of CATCH, CATCH2, CHALICE, PECARN, SNC16, PREDICT, and NICE23, both within guideline-specific application cohorts and across the full study cohort. The primary comparative outcome was significant trauma-related findings on cranial computed tomography (cCT). Secondary outcomes were neurosurgical interventions and guideline-specific endpoints. The study was registered at ClinicalTrials.gov (NCT05964764).
Findings:
The full cohort consisted of 3012 children (median age, 5.6 years; SD, 4.8). Among these, 0.9% (27/3012) had significant cCT findings, and 2/3012 (0.07%) required neurosurgery. CATCH and CATCH2 could be applied to 31.0% (934/3012) of patients, whereas the remaining guidelines were applicable to >94% of the cohort. In a comparative analysis concerning significant cCT findings, the lowest sensitivity estimates were 74.1% (95% CI: 53.7-88.9) for both PECARN ≥2 years and PREDICT ≥2 years; the highest was 100% (95% CI: 87.2-100.0) for SNC16. Specificity ranged from 41.6% (95% CI: 39.8-43.4) for SNC16 to 78.3% (95% CI: 76.8-79.8) for CHALICE. Mandatory cCT rates varied from 1.2% (PREDICT ≥2 years) to 29.9% (CATCH2).
Interpretation:
A head-to-head comparison in a real-world, paediatric, TBI cohort highlights key features of established guidelines and decision rules, offering insight into their comparative diagnostic accuracy, practical application and clinical impact.
Funding:
This work was supported by non-commercial state funding from Södra Sjukvårdsregionen, Vetenskapliga Rådet (Hallands Hospital), and Forskning och Utveckling Halland.
