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G273 Accuracy of Physician Practice as Compared with Pecarn, Catch and Chalice Head Injury Clinical Decision Rules in Children. A Predict Prospective Cohort Study
  1. MD Lyttle1,2,3,4,5,
  2. M Borland1,6,7,
  3. N Phillips1,8,
  4. A Kochar1,9,
  5. JA Cheek1,2,3,10,
  6. Y Gilhotra1,8,
  7. J Furyk1,11,
  8. J Neutze1,12,
  9. S Bressan1,3,
  10. S Donath3,13,
  11. C Molesworth3,
  12. L Crowe3,
  13. E Oakley1,2,3,13,
  14. SR Dalziel1,14,15,
  15. FE Babl1,2,3,13
  1. 1Paediatric Research in Emergency Departments International Collaborative (PREDICT), Australia/New Zealand
  2. 2Emergency Department, Royal Children’s Hospital, Melbourne, Australia
  3. 3Murdoch Children’s Research Institute, Melbourne, Australia
  4. 4Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  5. 5Faculty of Health and Applied Science, University of the West of England, Bristol, UK
  6. 6Emergency Department, Princess Margaret Hospital for Children, Perth, Australia
  7. 7Schools of Paediatrics and Child Health and Primary, Aboriginal and Rural Healthcare, University of Western Australia, Perth, Australia
  8. 8Emergency Department, Lady Cilento Children’s Hospital, Brisbane, Australia
  9. 9Emergency Department, Women’s and Children’s Hospital, Adelaide, Australia
  10. 10Emergency Department, Monash Medical Centre, Melbourne, Australia
  11. 11Emergency Department, The Townsville Hospital, Townsville, Australia
  12. 12Emergency Department, Kidzfirst Middlemore Hospital, Auckland, New Zealand
  13. 13Emergency Department, Starship Children’s Health, Auckland, New Zealand
  14. 13Department of Paediatrics, University of Melbourne, Melbourne, Australia
  15. 14Emergency Department, Starship Children’s Health, Auckland, New Zealand
  16. 15Emergency Department, Bristol Royal Hospital for Children, Bristol, UK

Abstract

Aims Clinical decision rules (CDRs) can assist in determining the need for computed tomography (CT) in children with head injuries (HIs). We assessed the accuracy of 3 high quality CDRs (PECARN, CATCH and CHALICE) in a large prospective cohort of head injured children. However in addition to CDR accuracy, the baseline physician accuracy is one of a number of factors which are also important when determining whether a particular rule should be implemented. The objective of this study was to assess the diagnostic accuracy of physician practice in detecting clinically important traumatic brain injuries.

Methods Prospective observational study of children<18 years with HIs of any severity at 10 mainly tertiary Australian/New Zealand centres. We extracted a cohort of children with mild HIs (GCS 13–15, presenting <24 hour) and assessed physician accuracy for the standardised outcome of clinically important traumatic brain injury (ciTBI); we compared this with the diagnostic accuracy of the PECARN, CATCH and CHALICE CDRs. Physician accuracy was calculated based on whether CT was obtained during the initial Emergency Department (ED) visit.

Results Of 20 137 children, 18 913 had a mild HI as defined. Of these 1578 (8.3% = actual CT rate) received a CT scan during the ED visit; 160 (0.8%) had a ciTBI and 24 (0.1%) underwent neurosurgery. Physician practice accuracy for detecting ciTBI based on whether CT was performed had a sensitivity of 157/160 ((98.1% (94.6%–99.6%) and a specificity of 17,332/18,753 (92.4% (92.0%–92.8%)). Sensitivity of PECARN <2 years was 42/42 (100.0%, 91.6% to 100.0%), PECARN ≥2 years 117/118 (99.2%; 95.4% to 100.0%), CATCH (high/medium risk) 147/ 160 (91.9%; 86.5% to 95.6%) and CHALICE 148/160 (92.5%; 87.3% to 96.1%). Projected CT rates for PECARN ≤2/≥2 years were 8.0%/9.4% (high risk only) to 41.4%/48.5% (high and intermediate risk factors, considering the unlikely scenario that all patients in the intermediate risk group receive a CT scan), for CATCH 30.2% (medium and high risk) and for CHALICE 22.0%.

Conclusions Physician accuracy was high. The implementation of PECARN, CATCH or CHALICE CDRs in this setting has the potential to increase the CT rate with limited potential to increase the accuracy of detecting ciTBI.

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