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Paediatric head injury

Paediatric head injury. Dr Cynthia Lim July 2012. 3 big ones. CATCH CHALICE PECARN CATCH and CHALICE identify kids who need CTB PECARN identify kids who don’t. CATCH. Multicentre cohort 3866 blunt head trauma 90% GCS 15 Derived decision rule based on high risk and medium risk factors

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Paediatric head injury

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  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%

  7. 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

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

  9. 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

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

  11. 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

  12. Isolated vomiters • PECARN • 1228 isolated vomiters • Neurosurgical rate 0.1%

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