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)

Table 3 Comparison of outcomes[11, 15–17]

	Primary outcome	Secondary outcomes
CATCH	Need for neurological intervention, defined as death within 7 days secondary to the head injury or need for any of the following within 7 days: craniotomy, elevation of skull fracture, monitoring of intracranial pressure, insertion of endotracheal tube for the management of head injury	Brain injury on CT, defined as any acute intracranial finding revealed on CT attributable to acute injury, including closed depressed skull fracture (depressed past the inner table) and pneumocephalus but excluding non-depressed skull fractures and basilar skull fractures
CHALICE	Clinically significant intracranial injury (CSII), defined as death as a result of head injury, requirement for neurosurgical intervention, marked abnormality on CT (any new, acute, traumatic intracranial pathology as reported by consultant radiologist, including intracranial haematomas of any size, cerebral contusion, diffuse cerebral oedema and depressed skull fractures)	Presence of skull fracture Admission to hospital
PECARN	Clinically important traumatic brain injury (ciTBI), defined as death from TBI, neurosurgical intervention for TBI (intracranial pressure monitoring, elevation of depressed skull fracture, ventriculostomy, haematoma evacuation, lobectomy, tissue debridement, dura repair, other), intubation of more than 24 h for TBI or hospital admission of 2 nights or more for TBI* in association with TBI on CT**	None

Reproduced from Lyttle M, et al.[15] Copyright 2012, with permission from BMJ Publishing Group Ltd.
*Admission for persistent neurological symptoms or signs such as persistent alteration in mental status, recurrent emesis due to head injury, persistent severe headache or ongoing seizure management.
**Intracranial haemorrhage or contusion, cerebral oedema, traumatic infarction, diffuse axonal injury, shearing injury, sigmoid sinus thrombosis, midline shift of intracranial contents or signs of brain herniation, diastasis of the skull, pneumocephalus, skull fracture depressed by at least the width of the table of the skull.
CATCH Canadian Assessment of Tomography for Childhood Head Injury.
CHALICE Children’s Head Injury Algorithm for the Prediction of Important Clinical Events.
PECARN Pediatric Emergency Care Applied Research Network.
CT computed tomography.

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