Applicability of CT examination decision rules in head injured children

Objective To explore the applicability of the three commonly used CT examination decision rules in Chinese head injured children. Methods This prospective observational study included 1 538 children and adolescents (aged <18 years), who were treated at the Emergency Department of First Hospital of Shanxi Medical University after head injuries. The three clinical decision rules include the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE; UK); the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury, that was developed by the Pediatric Emergency Care Applied Research Network (PECARN; USA), and the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) rule. Diagnostic accuracy had been evaluated by using the rule-specific predictor variables to predict each rule-specific outcome measure in populations who met inclusion and exclusion criteria for each rule. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and ROC curve were referred to the diagnostic accuracy. Indicators were characterized by 95% CI. Results Of the 1 538 patients, CTs were obtained for 339 patients (22.04%). Forty-nine patients (3.19%) had positive CT results, 8 patients (0.52%) underwent neurosurgery, 2 patients (0.13%) died, and 1 patient (0.07%) may be missed. In this study, CHALICE was applied for 1 394 children (90.70%; 95% CI: 89.24%-92.15%), PECARN for 801 children (52.11%; 95% CI: 49.62%-54.61%), and CATCH for 325 patients (21.15%; 95% CI: 19.10%-23.19%). The validation sensitivities of CHALICE, PECARN, and CATCH rules were 92.6% (74.2%-98.7%), 100% (56.1%-100%), and 85.7% (42.0%-99.2%), respectively; the specificities were 78.1% (75.7%-80.2%), 48.0% (44.5%-51.5%) and 70.8% (65.4%-75.6%); positive predictive value were 7.7% (5.1%-11.3%), 0.9% (0.4%-1.9%) and 6.1% (2.5%-13.2%); and negative predictive value were 99.8% (99.2%-100%), 99.1% (98.1%-99.6%), and 99.6% (97.2%-100%), respectively. Conclusions The clinical decision rules of CHALICE, PECARN and CATCH have high sensitivities. The specificity of PECARN rule is lower than those of CHALICE and CATCH rules. The above three clinical decision rules can be used for the decision of CT examination in Chinese children with head injury in practice. Key words: Children; Head trauma; CT examination; Clinical decision rules; Applicability; CATCH; PECARN; CHALICE