Evaluation of computed tomography requirement in children with mild head trauma according to PECARN, CATCH, CHALICE scales

Objective: In our study, the PECARN, CATCH, and CHALICE scales, which are the most commonly used diagnostic decision-making scales, were compared and it was aimed to determine the scale with stronger diagnostic accuracy in the selection of patients who will undergo computed tomography and in predicting clinically significant traumatic brain injury, the need for neurological intervention, and clinically significant intracranial injury. Material and Method: Within the scope of the study, the data of 520 children with head trauma brought to Çukurova University Medical Faculty Hospital Pediatric Emergency Service between January 2016 and December 2020 were compiled. The demographic data of the patients included in the study, head trauma etiology, admission symptoms, Glasgow coma scores, data on computed tomography, results of the PECARN, CATCH and CHALICE scales obtained from the patients, and the results of the patients' admission to the emergency department were recorded. The data of the patients were accessed through the hospital information management system (HIMS) and archive files and recorded in the data form. PECARN, CATCH and CHALICE scale results, computed tomography findings and emergency department outcome data of the patients were compared with each other. Results: Sixty-four percent of children with head trauma were male. Sixteen point nine percent of the patients were under 2 years old, 53.3% were between 2-10 years old and 29.8% were over 10 years old. Cranial computed tomography findings were found in 17.1% of the patients. The most common findings were subgaleal hematoma with 9.4%, skull fracture with 5% and intraventricular hemorrhage with 1.2%, respectively. It was observed that 90.4% of the patients with PECARN, 75.2% with CATCH, and 58.7% with CHALICE, which are among the scales used to predict traumatic brain injury, were indicated. Findings were detected in 6% of the patients who were not indicated for tomography according to the PECARN scale. It was found that 19.1% of the patients who were indicated with PECARN had tomography findings. It was determined that none of the patients who did not have a tomography indication were hospitalized and no neurosurgical intervention was applied to any of them. The positive predictive value of the PECARN scale in terms of tomography finding was 19.1% and the negative predictive value was 94%. Findings were detected in 10.1% of patients who did not have a tomography indication according to the CATCH scale. It was determined that 20.5% of the patients who were indicated with CATCH had tomography findings. It was determined that 0.8% of the patients who did not have a tomography indication were hospitalized and none of them underwent neurosurgical intervention. The positive predictive value of the CATCH scale in terms of tomography finding was 20.5% and the negative predictive value was 89.9%. Findings were detected in 11.6% of the patients who did not have a tomography indication according to the CHALICE scale. It was found that 22.3% of the patients who were indicated with CHALICE had tomography findings. It was determined that 2.3% of the patients who did not have a tomography indication were hospitalized and none of them underwent neurosurgical intervention. The positive predictive value of the CHALICE scale in terms of tomography finding was 22.3% and the negative predictive value was 88.4%. Conclusion: As a result of our study, it was seen that the PECARN, CATCH and CHALICE scales were sufficient to make the decision to apply computed tomography in pediatric patients admitted to the emergency services due to head trauma. However, keeping in mind that patients who are excluded in the application of computed tomography with these scales, although rare, may have traumatic brain injury, these patients should be evaluated once again with clinical experience. Key Words: CATCH, CHALICE, Child, Mild, Head injury, PECARN