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Research

CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury

Martin H. Osmond, Terry P. Klassen, George A. Wells, Rhonda Correll, Anna Jarvis, Gary Joubert, Benoit Bailey, Laurel Chauvin-Kimoff, Martin Pusic, Don McConnell, Cheri Nijssen-Jordan, Norm Silver, Brett Taylor, Ian G. Stiell and ; for the Pediatric Emergency Research Canada (PERC) Head Injury Study Group
CMAJ March 09, 2010 182 (4) 341-348; DOI: https://doi.org/10.1503/cmaj.091421
Martin H. Osmond
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Terry P. Klassen
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George A. Wells
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Rhonda Correll
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Anna Jarvis
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Gary Joubert
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Benoit Bailey
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Laurel Chauvin-Kimoff
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Martin Pusic
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Don McConnell
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Cheri Nijssen-Jordan
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Norm Silver
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Brett Taylor
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Ian G. Stiell
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Abstract

Background: There is controversy about which children with minor head injury need to undergo computed tomography (CT). We aimed to develop a highly sensitive clinical decision rule for the use of CT in children with minor head injury.

Methods: For this multicentre cohort study, we enrolled consecutive children with blunt head trauma presenting with a score of 13–15 on the Glasgow Coma Scale and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. For each child, staff in the emergency department completed a standardized assessment form before any CT. The main outcomes were need for neurologic intervention and presence of brain injury as determined by CT. We developed a decision rule by using recursive partitioning to combine variables that were both reliable and strongly associated with the outcome measures and thus to find the best combinations of predictor variables that were highly sensitive for detecting the outcome measures with maximal specificity.

Results: Among the 3866 patients enrolled (mean age 9.2 years), 95 (2.5%) had a score of 13 on the Glasgow Coma Scale, 282 (7.3%) had a score of 14, and 3489 (90.2%) had a score of 15. CT revealed that 159 (4.1%) had a brain injury, and 24 (0.6%) underwent neurologic intervention. We derived a decision rule for CT of the head consisting of four high-risk factors (failure to reach score of 15 on the Glasgow coma scale within two hours, suspicion of open skull fracture, worsening headache and irritability) and three additional medium-risk factors (large, boggy hematoma of the scalp; signs of basal skull fracture; dangerous mechanism of injury). The high-risk factors were 100.0% sensitive (95% CI 86.2%–100.0%) for predicting the need for neurologic intervention and would require that 30.2% of patients undergo CT. The medium-risk factors resulted in 98.1% sensitivity (95% CI 94.6%–99.4%) for the prediction of brain injury by CT and would require that 52.0% of patients undergo CT.

Interpretation: The decision rule developed in this study identifies children at two levels of risk. Once the decision rule has been prospectively validated, it has the potential to standardize and improve the use of CT for children with minor head injury.

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Canadian Medical Association Journal: 182 (4)
CMAJ
Vol. 182, Issue 4
9 Mar 2010
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CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury
Martin H. Osmond, Terry P. Klassen, George A. Wells, Rhonda Correll, Anna Jarvis, Gary Joubert, Benoit Bailey, Laurel Chauvin-Kimoff, Martin Pusic, Don McConnell, Cheri Nijssen-Jordan, Norm Silver, Brett Taylor, Ian G. Stiell
CMAJ Mar 2010, 182 (4) 341-348; DOI: 10.1503/cmaj.091421

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CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury
Martin H. Osmond, Terry P. Klassen, George A. Wells, Rhonda Correll, Anna Jarvis, Gary Joubert, Benoit Bailey, Laurel Chauvin-Kimoff, Martin Pusic, Don McConnell, Cheri Nijssen-Jordan, Norm Silver, Brett Taylor, Ian G. Stiell
CMAJ Mar 2010, 182 (4) 341-348; DOI: 10.1503/cmaj.091421
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  • Guidelines for mild head injuries in children
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  • Office management of mild head injury in children and adolescents
  • Prise en charge en cabinet des lesions cerebrales traumatiques legeres chez les enfants et les adolescents
  • Diagnosis and acute management of patients with concussion at children's hospitals
  • Applicability of the CATCH, CHALICE and PECARN paediatric head injury clinical decision rules: pilot data from a single Australian centre
  • Predicting and preventing postconcussive problems in paediatrics (5P) study: protocol for a prospective multicentre clinical prediction rule derivation study in children with concussion
  • Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians
  • Safety and efficacy of symptom-driven CT decision rule in fully conscious paediatric patients with symptoms after mild closed head trauma
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  • The Effect of Observation on Cranial Computed Tomography Utilization for Children After Blunt Head Trauma
  • Sport-Related Concussion in Children and Adolescents
  • Incidence of Delayed Intracranial Hemorrhage in Children After Uncomplicated Minor Head Injuries
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