Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department.

Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. CMAJ. 2018 Jul 09;190(27):E816-E822 Authors: Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, Gouin S, Khangura S, Turner T, Belanger F, Silver N, Taylor B, Curran J, Stiell IG, Pediatric Emergency Research Canada (PERC) Head Injury Study Group Abstract BACKGROUND: There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. METHODS: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Phys icians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule. RESULTS: Of 4060 enrolled patients, 23 (0.6%) underwen...
Source: cmaj - Category: General Medicine Authors: Tags: CMAJ Source Type: research