Comparison of PECARN, CATCH, CHALICE guidelines and clinical decisions of pediatricians in head trauma patients admitted to the pediatric emergency department

Head trauma in children constitutes a significant part of the emergency service applications.In the United States, approximately 600,000 patients under the age of 18 apply to emergency services every year; It has been reported that over 60000 hospitalizations were made and 7400 children died because of this.According to the results of another study from England; Between 2000 and 2011, there was a 10% increase in the number of patients admitted to emergency departments due to head trauma.In our country, especially in the pediatric age group, the number of patients who apply to the emergency services due to head trauma is high, and it is among the diseases that cause serious mortality and morbidity in the pediatric age group.Early recognition and correct guidance of patients with severe head trauma by pediatric emergency physicians is extremely important to reduce morbidity and mortality.Majority of the patients admitted to the emergency department are minor head traumas without clinical symptoms or signs.Traumatic brain injury, which is an important cause of disability and death in childhood, is a process that includes pathophysiological changes in the brain tissue caused by external mechanical forces, has the possibility to affect temporary or permanent cognitive, physical and psychosocial functions, and is accompanied by decreased or variable consciousness. Computed brain tomography (CT) is accepted as the gold standard method for detecting intracranial injuries in patients presenting with head trauma.Although CT provides a precise and rapid diagnosis to confirm or exclude intracranial injuries, radiation for children who are still at the age of growth also raises concerns that there may be a risk of cancer that may develop in later life.In addition, the fact that sedation may be required for CT from time to time also causes a separate risk and concern for families and the patient.In recent years, it has been reported that there has been a great increase in the rates of CT application in pediatric head injuries with increasing malpractice cases.The wide increase in CT use is a concern for child health.Again, its widespread and unnecessary use causes an increase in health costs.Clinical decision rules have been developed in the light of science to determine the best CT indications in pediatric patients presenting with head trauma. Three clinical decision rules from large multicenter studies of high methodological quality are; PECARN (Pediatric Emergency Care Applied Research Network), CATCH (Canadian Assessment of Tomography for Childhood Head Injury) and CHALICE (Children‟s Head Injury Algorithm for the Prediction of Important Clinical Events ). Our aim in this study is to evaluate the diagnostic performance of PECARN, CATCH and CHALICE rules in our society and to determine their validity. We retrospectively analyzed the findings of physical examination findings of patients under 18 years old who were admitted to Mersin University Medical Faculty Hospital Emergency Medical Clinic between 01/01/2019-31/12/2021 due to head trauma CT outcomes and treatments were retrospectively reviewed. A total of 1162 patients were eligible for PECARN 1162, CATCH 1157, and CHALICE 1154 patients. Pathological CT findings were detected in 98 of the patients. The sensitivity of the PECARN rule was 62.2%, the specificity was 79,05%, the sensitivity of the CATCH rule was 53,1, the specificity was 83,7%, the sensitivity of the CHALICE rule was 46,9%, and the specificity was 84,6%. Given the populations to which the rules apply, it is understood that the PECARN rule is more determinative in detecting pathological CT outcomes according to CHALICE and CATCH.