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儿童头部损伤决定规则的PECARN,CATCH和CHALICE准确性:一个前性队列研究

Franz E Babl¹, Meredith L Borland², Natalie Phillips³

¹Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia.

Lancet (London, England)

|April 16, 2017

概括

三个临床决策规则 (PECARN,CATCH,CHALICE) 显示了在头部受伤儿童中识别创伤性脑损伤 (TBI) 的高度敏感性. 这些经过验证的规则为临床实践提供了可靠的起点.

科学领域:

儿童紧急医疗
临床决策支持系统
神经创伤

背景情况:

临床决策规则有助于确定儿童头部损伤需要CT扫描.
需要对现有规则 (PECARN,CATCH,CHALICE) 在一个大型儿科队列中进行验证.

研究的目的:

在头部受伤的儿童中前性验证PECARN,CATCH和CHALICE临床决策规则的诊断准确性.
评估这些规则在预测临床重要创伤性脑损伤 (TBI) 和其他结果方面的表现.

主要方法:

在十个澳大利亚和新西兰医院对超过20,000名头部受伤的儿童进行前性观察研究.
评估PECARN的诊断准确性 (按年龄分层<2岁和≥2岁),CATCH和CHALICE对于规则特定的结果.
在轻度头部损伤队列 (n=18,913) 中对临床重要TBI进行二次分析.

主要成果:

PECARN显示出最高的灵敏度 (100%为<2年,99%为≥2年).
同时,CATCH和CHALICE的敏感度也很高 (分别为95. 2%和92. 3%).
所有规则显示临床重要TBI的负预测值超过99%.

结论:

经过验证的临床决策规则 (PECARN,CATCH,CHALICE) 对儿童严重头部损伤的识别具有高度敏感性.
这些发现支持在临床实践中实施这些规则,以指导CT成像决策.

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