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Comparison of CATCH, PECARN and CHALICE rules in children with minor head trauma
Mehmet Esat Ferhatlar1, Bilgehan Ahmet Cumhur2, Yavuzselim Koca3
1Department of Emergency Medicine, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, 34100, Türkiye. dresatferhatlar@gmail.com.
Insights
The Pediatric Emergency Care Applied Research Network (PECARN) criteria show high sensitivity for detecting brain CT pathology in pediatric head trauma but result in more scans. The CHALICE criteria reduce scans but may miss cases.
Area of Science:
- Emergency Medicine
- Pediatric Traumatology
- Radiology Decision Support
Background:
- Minor head trauma is common in children presenting to emergency departments.
- Clinical decision rules aim to optimize neuroimaging use in pediatric head trauma.
- Rural emergency departments face unique challenges in managing these cases.
Purpose of the Study:
- To prospectively compare the diagnostic performance of PECARN, CATCH, and CHALICE clinical decision rules.
- Evaluate these rules in a resource-limited rural secondary-level emergency department.
- Assess their utility in pediatric patients with minor head trauma.
Main Methods:
- Prospective observational study design.
- Application of PECARN, CATCH, and CHALICE rules to 1,032 pediatric patients.
- Statistical analysis using SPSS version 27, with p < 0.05 considered significant.
Main Results:
- PECARN demonstrated 100% sensitivity and 52.1% specificity for pathological brain CT.
- CATCH had 93.3% sensitivity and 53.3% specificity.
- CHALICE showed 86.7% sensitivity and 87.8% specificity.
- PECARN identified all positive cases but had a high false-positive rate.
Conclusions:
- PECARN criteria are highly sensitive for brain CT pathology in pediatric head trauma.
- PECARN criteria may lead to an increased number of brain CT scans.
- CHALICE criteria can reduce unnecessary scans but risk missing positive findings.
Purpose:
The aim of this study is to prospectively compare the diagnostic performance of the PECARN, CATCH, and CHALICE clinical decision rules in pediatric patients presenting with minor head trauma, within a rural secondary-level emergency department characterized by limited resources, high patient volume, and restricted access to specialist physicians.
Methods:
The study was designed as a prospective observational study. The PECARN, CATCH, and CHALICE clinical decision rules were applied to the patients included in the study, and the data were recorded. The data included in the study were statistically analyzed using the SPSS (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL) 27 program. A value of p < 0.05 was considered statistically significant.
Results:
A total of 1,032 patients were included in the study. The PECARN did not miss any of the 15 patients with pathological brain CT and had 100% sensitivity and 52.1% specificity. CATCH failed to detect pathological brain CT in 1 patient and had 93.3% sensitivity and 53.3% specificity. CHALICE failed to detect pathological brain CT in 2 patients, with 86.7% sensitivity and 87.8% specificity. Overall, PECARN was more successful in detecting pathological brain CT, but it also had a high false-positive brain CT rate.
Conclusion:
PECARN criteria are more sensitive than other criteria in predicting brain CT pathology, but they lead to a large number of brain CT scans. While the CHALICE criteria are beneficial in reducing unnecessary brain CT scans, they may miss positive cases.
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