Transcript Paediatric head injury

Paediatric head injury
Dr Cynthia Lim
July 2012
3 big ones
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CATCH
 CHALICE
 PECARN
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CATCH and CHALICE identify kids who
need CTB
 PECARN identify kids who don’t
CATCH
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Multicentre cohort
3866 blunt head trauma
90% GCS 15
Derived decision rule based on high risk and
medium risk factors
High risk factors 100% sensitive, 30% underwent
CTB
Medium risk factors 98.1% sensitive, 52%
underwent CTB
Not validated
CATCH inclusion
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GCS 13-15
 LOC
 Amnesia
 Disorientation
 Persistent vomiting
 Irritability
CATCH results
GCS 13 – 2.5%
 GCS 14 – 7.3%
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CTB found 4.1% brain injury
 0.6% neurological intervention
CHALICE
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22 772
65% boys
56% under 5yrs
0.1% (281) abnormal CTB
0.006% (137) neurosurgical
15 died
Derived rule with 98% sensitivity for clinically
significant head injury
CTB rate of 14%
PECARN
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Validated
 42 412
 Age under 2 years, age older than 2 years
 Excluded ground level falls
 35% CTB rate
 ciTBIs 0.9%
 0.1% neurosurgery
PECARN age under 2 years
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Derivation pop 8502
 Validation pop 2216
 694 underwent CTB
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NPV ciTBI 100%
 Sensitivity 100%
PECARN age under 2
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Prediction rule
– Normal mental status
– No scalp haematoma (except frontal)
– No LOC or LOC less than 5sec
– Non severe mechanism
– No palpable skull #
– Acting normally acc to parents
PECARN age over 2
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Derivation pop 25 283
 Validation pop 6411
 2223 underwent CTB
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NPV ciTBI 99.95%
 Sensitivity 96.8%
What about isolated vomiting?
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2 out of 3 included vomiting
 CHALICE
 857 vomited more than 3 times (3.8%)
 56 of these children had a significant
brain injury on CT. 801 did not.
 6.5% risk serious brain injury if vomits 3
or more, but not isolated vomiters
Isolated vomiters
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PECARN
 1228 isolated vomiters
 Neurosurgical rate 0.1%