1. Paediatric head injury Dr Cynthia Lim July 2012

2. 3 big ones CATCH CHALICE PECARN CATCH and CHALICE identify kids who need CTB PECARN identify kids who don’t

3. CATCH 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

4. CATCH inclusion GCS 13-15 LOC Amnesia Disorientation Persistent vomiting Irritability

5. CATCH results GCS 13 – 2.5% GCS 14 – 7.3% CTB found 4.1% brain injury 0.6% neurological intervention

6. CHALICE 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%

8. PECARN 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

9. PECARN age under 2 years Derivation pop 8502 Validation pop 2216 694 underwent CTB NPV ciTBI 100% Sensitivity 100%

10. PECARN age under 2 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

11. PECARN age over 2 Derivation pop 25 283 Validation pop 6411 2223 underwent CTB NPV ciTBI 99.95% Sensitivity 96.8%

13. What about isolated vomiting? 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

14. Isolated vomiters PECARN 1228 isolated vomiters Neurosurgical rate 0.1%