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Table 1 Comparison of predictor variables[11, 1517]

From: A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST)

CATCH CHALICE PECARN <2 years PECARN ≥2 years
Mechanism of injury
Dangerous mechanism of injury (eg MVC, fall from elevation ≥3 ft [≥0.91 m] or 5 stairs, fall from bicycle with no helmet). High speed RTA as pedestrian, cyclist, occupant (>40 miles/h or >64 km/h). Severe mechanism of injury (MVC with patient ejection, death of another passenger or rollover; pedestrian/bicyclist without helmet struck by motorized vehicle; falls >0.9 m; head struck by high impact object). Severe mechanism of injury (MVC with patient ejection, death of another passenger or rollover; pedestrian/bicyclist without helmet struck by motorized vehicle; falls >1.5 m; head struck by high impact object).
Fall of > 3 m in height.
High speed injury from projectile or object.
History
  Witnessed LOC > 5 min. LOC ≥5 seconds. Any/suspected LOC.
  Amnesia (antegrade or retrograde) >5 min.   
   Altered mental status. Altered mental status.
   Not acting normally per parent.  
  ≥3 vomits after head injury (discrete episodes).   History of vomiting.
  Suspicion of NAI.   
  Seizure in patient with no history of epilepsy.   
History of worsening headache.    Severe headache.
Examination
GCS <15, 2 hr after injury. GCS <14, or <15 if <1 yr. GCS < 15 GCS < 15
Irritability on examination. Abnormal drowsiness (in excess of that expected by examining doctor). Other signs of altered mental status (agitation, somnolence, repetitive questioning, slow response to verbal communication) Other signs of altered mental status (agitation, somnolence, repetitive questioning, slow response to verbal communication)
Suspected open or depressed skull fracture. Suspicion of penetrating or depressed skull injury, or tense fontanelle.   
Any sign of basal skull fracture (eg haemotympanum, “raccoon” eyes, otorrhoea/rhinorrhoea of CSF, Battle’s sign). Signs of basal skull fracture. Palpable or unclear skull fracture. Clinical signs of basilar skull fracture.
  Positive focal neurology.   
Large boggy haematoma of the scalp. Presence of bruise, swelling or laceration > 5 cm if < 1 yr old. Occipital, parietal or temporal scalp haematoma.  
  1. Reproduced from Lyttle M, et al.[15] Copyright 2012, with permission from BMJ Publishing Group Ltd.
  2. In each of the three clinical decision rules (CDRs) the absence of all of the above predictor variables indicates that cranial computed tomography is unnecessary.
  3. Note: while the predictor variables are reproduced verbatim, the order in which the variables from each CDR are presented has been altered to facilitate comparison.
  4. CATCH Canadian Assessment of Tomography for Childhood Head Injury.
  5. CHALICE Children’s Head Injury Algorithm for the Prediction of Important Clinical Events.
  6. PECARN Pediatric Emergency Care Applied Research Network.
  7. MVC Motor vehicle crash.
  8. RTA Road traffic accident.
  9. LOC Loss of consciousness.
  10. NAI Non-accidental injury.
  11. GCS Glasgow Coma Score.
  12. CSF Cerebrospinal fluid.