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The development of prediction rules is complicated, involving the derivation of reliable rules, followed by prospective validation in a different group of patients. Rule development is further complicated when there is debate about the appropriate outcome or when the outcome is rare and cost must be considered. For example, there has been a great deal of energy spent on the appropriate diagnostic process for adults with possible deep vein thrombosis (DVT). There is general agreement that DVT, rather than complications of DVT, are the appropriate outcome and since DVT is not rare little work has been done about the cost-effectiveness of these rules. In a paper from Dunning and colleagues from Manchester Royal Infirmary, the authors describe the development of the children’s head injury algorithm for the prediction of important clinical events (CHALICE) rule for the prediction of important clinical events for children with head trauma. There aim was to
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