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

Osmond, Martin H.; Klassen, Terry P.; Wells, George A.; Correll, Rhonda; Jarvis, Anna; Joubert, Gary; Bailey, Benoît; Chauvin-Kimoff, Laurel; Pusic, Martin; McConnell, Don; Nijssen–Jordan, Cheri; Silver, Norm; Taylor, Brett; Stiell, Ian G.

doi:10.1503/cmaj.091421

Cited by 429 publications

(220 citation statements)

References 38 publications

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“…Furthermore, injuries needing neurosurgical treatment are very uncommon in children with GCS scores of 14-15 [22]. Martin et al [10] found that only 0.6% of children with TBI needed neurosurgical intervention; a similar percentage (1.5%) was found by Guzel and coworkers [15]. In the present study, we found that 4.6% of patients needed neurosurgical intervention.…”

Section: Discussionsupporting

confidence: 87%

“…Computed tomography (CT) of the head is the gold standard for the diagnosis of complications from TBI. There are different guidelines [3,[5][6][7] available for the management of TBI and variable CT indications, and few of them validated for the pediatric population are about minor head injury [7][8][9][10]. In Italy, few clinical studies about pediatric head trauma have been documented [4].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature

et al. 2012

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The best way to manage children with minor head trauma is still matter of debate. Loss of consciousness and scalp swelling are risk factors predicting brain injury that deserve CT control. The radiation risks posed by CT scanning in children must be balanced by the benefits. We believe that even though CT scans may be clinically unnecessary in many cases, the rate of scanning is justified by the even limited number of abnormalities which require neurosurgical treatment.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature

et al. 2012

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“…9 Including 10 events per each candidate predictor variable, 17 345 cases of PPCS would be required after screening for acceptable interrater agreement, assuming a dropout rate of 25% for the a priori selected variables. 27 To obtain 345 cases of PPCS, 1380 patients with new concussion had to be enrolled. Factoring a loss to follow-up rate of 23% based on pilot data, 28 the final derivation cohort sample size required was 1792 patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED

Zemek

Barrowman

Freedman

et al. 2016

JAMA

650

684

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for the Pediatric Emergency Research Canada (PERC) Concussion Team IMPORTANCE Approximately one-third of children experiencing acute concussion experience ongoing somatic, cognitive, and psychological or behavioral symptoms, referred to as persistent postconcussion symptoms (PPCS). However, validated and pragmatic tools enabling clinicians to identify patients at risk for PPCS do not exist. OBJECTIVE To derive and validate a clinical risk score for PPCS among children presenting to the emergency department. DESIGN, SETTING, AND PARTICIPANTS Prospective, multicenter cohort study (Predicting and Preventing Postconcussive Problems in Pediatrics [5P]) enrolled young patients (aged 5-<18 years) who presented within 48 hours of an acute head injury at 1 of 9 pediatric emergency departments within the Pediatric Emergency Research Canada (PERC) network from August 2013 through September 2014 (derivation cohort) and from October 2014 through June 2015 (validation cohort). Participants completed follow-up 28 days after the injury. EXPOSURES All eligible patients had concussions consistent with the Zurich consensus diagnostic criteria. MAIN OUTCOMES AND MEASURES The primary outcome was PPCS risk score at 28 days, which was defined as 3 or more new or worsening symptoms using the patient-reported Postconcussion Symptom Inventory compared with recalled state of being prior to the injury. RESULTS In total, 3063 patients (median age, 12.0 years [interquartile range, 9.2-14.6 years]; 1205 [39.3%] girls) were enrolled (n = 2006 in the derivation cohort; n = 1057 in the validation cohort) and 2584 of whom (n = 1701 [85%] in the derivation cohort; n = 883 [84%] in the validation cohort) completed follow-up at 28 days after the injury. Persistent postconcussion symptoms were present in 801 patients (31.0%) (n = 510 [30.0%] in the derivation cohort and n = 291 [33.0%] in the validation cohort). The 12-point PPCS risk score model for the derivation cohort included the variables of female sex, age of 13 years or older, physician-diagnosed migraine history, prior concussion with symptoms lasting longer than 1 week, headache, sensitivity to noise, fatigue, answering questions slowly, and 4 or more errors on the Balance Error Scoring System tandem stance. The area under the curve was 0.71 (95% CI, 0.69-0.74) for the derivation cohort and 0.68 (95% CI, 0.65-0.72) for the validation cohort. CONCLUSIONS AND RELEVANCEA clinical risk score developed among children presenting to the emergency department with concussion and head injury within the previous 48 hours had modest discrimination to stratify PPCS risk at 28 days. Before this score is adopted in clinical practice, further research is needed for external validation, assessment of accuracy in an office setting, and determination of clinical utility.

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“…4 Seven predictors of abnormal CT-scan findings in patients with concussion have been identified: headache, vomiting, age >60 years, intoxication, deficit in short-term memory (persistent anterograde amnesia), physical evidence of any trauma above the clavicle, and seizure. [20][21][22] Although identified in the New Orleans Criteria as indications for head CT scanning, neither seizure nor mild/moderate headache is a significant univariate predictor of intracranial injury. 3 Moreover, a clinical decision rule has been developed for use in a pediatric population: The Canadian Assessment of Tomography for Childhood Head Injury 22 has identified children at high risk who require neurologic intervention who have sustained a head injury within the previous 24 hours and have 1 of the following findings: GCS <15 at 2 hours after the injury, suspected open or depressed skull fracture, history of worsening headache, or irritability on examination.…”

Section: Non-english Abstracts Translated For Reviewmentioning

confidence: 99%

“…[20][21][22] Although identified in the New Orleans Criteria as indications for head CT scanning, neither seizure nor mild/moderate headache is a significant univariate predictor of intracranial injury. 3 Moreover, a clinical decision rule has been developed for use in a pediatric population: The Canadian Assessment of Tomography for Childhood Head Injury 22 has identified children at high risk who require neurologic intervention who have sustained a head injury within the previous 24 hours and have 1 of the following findings: GCS <15 at 2 hours after the injury, suspected open or depressed skull fracture, history of worsening headache, or irritability on examination. Children at medium risk and have sustained a head injury and have 1 of the following findings: any sign of basal skull fracture; large, boggy hematoma of the scalp; or dangerous mechanism of injury.…”

Section: Non-english Abstracts Translated For Reviewmentioning

confidence: 99%

Differentiating Concussion From Intracranial Pathology in Athletes

Cripps¹,

Livingston²

2017

Journal of Sport Rehabilitation

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Clinical Scenario: A cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objectives of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. Clinical ScenarioA cerebral concussion is a traumatically induced transient disturbance of brain function characterized by a complex pathophysiologic process and is classified as a subset of mild traumatic brain injury. 1 The occurrence of intracranial lesions after sport-related head injury is relatively uncommon, 2 but the possibility of serious intracranial injury (ICI) should be included in the differential diagnosis. ICIs are potentially life threatening and necessitate urgent medical management; therefore, prompt recognition and evaluation are critical to proper medical management. One of the primary objective of the initial evaluation is to determine if the concussed athlete has an acute traumatic ICI. 3 Athletic trainers must be able promptly recognize clinical signs and symptoms that will enable them to accurately differentiate between a concussion (ie, a closed head injury not associated with significant ICI) and an ICI. The identification of predictors of intracranial lesions is, however, relatively broad. 4 Focused Clinical QuestionWhich clinical examination findings (ie, clinical signs and symptoms) indicate possible intracranial pathology in individuals with acute closed head injuries?

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

Cited by 429 publications

References 38 publications

Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature

Brain CT scan for pediatric minor accidental head injury. An Italian experience and review of literature

Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED

Differentiating Concussion From Intracranial Pathology in Athletes

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