Babl F E., Gardiner K K., Kochar A., Wilson C.L., George S A., Zhang M., Furyk J., Thosar D., Cheek J A., Krieser D., Rao A S., Borland M.L., Cheng N., Phillips N.T., Sinn K K., Neutze J.M., Dalziel S R., PREDICT (Paediatric Research In Emergency Departments International Collaborative) Bell’s palsy in children: Current treatment patterns in Australia and New Zealand. A PREDICT study. J Paediatr Child Health. 2017 Feb 8. doi: 10.1111/jpc.13463. [link]

Long E., Cincotta D., Grindlay J., Pellicano A., Clifford M., Sabato S., Paediatric Research in Emergency Departments International Collaborative (PREDICT) Implementation of NAP4 emergency airway management recommendations in a quaternary-level pediatric hospital. Paediatr Anaesth. 2017 Feb 28. doi: 10.1111/pan.13128. [Link]

Babl F E., Mackay M T., Borland M L., Herd D W., Kochar A., Hort J., Rao A., Cheek J A., Furyk J., Barrow L., George S., Zhang M., Gardiner K., Lee K J., Davidson A., Berkowitz R., Sullivan F., Porrello E., Dalziel K M., Anderson V., Oakley E., Hopper S., Williams F., Wilson C., Williams A., Dalziel S R., PREDICT (Paediatric Research In Emergency Departments International Collaborative) research network. Bell’s Palsy in Children (BellPIC): protocol for a multicentre, placebo-controlled randomized trial. BMC Pediatr. 2017 Feb 13;17(1):53. doi: 10.1186/s12887-016-0702-y. [Link]

Oakley E., May R., Hoeppner T., Sinn K., Furyk J., Craig S., Rosengarten P., Kochar A., Krieser D., Dalton S., Dalziel S., Neutze J., Cain T., Jachno K., Babl FE., Paediatric Research in Emergency Departments International Collaborative (PREDICT). Computed tomography for head injuries in children: Change in Australian usage rates over time. Emerg Med Australas. 2017 Apr;29(2):192-197. doi: 10.1111/1742-6723.12732. PMID: 28332331 [Link]

Long E, Oakley E, Duke T, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness: A Systematic Review and Meta-Analysis. Shock. 2017 May;47(5):550-559. doi: 10.1097/SHK.0000000000000801. PMID: 28410544 [Link]

Oakley E, Chong V, Borland M, Neutze J, Phillips N, Krieser D, Dalziel S, Davidson A, Donath S, Jachno K, South M, Fry A, Babl FE.
Intensive care unit admissions and ventilation support in infants with bronchiolitis. Emerg Med Australas. 2017 May 19. doi: 10.1111/1742-6723.12778. [Epub ahead of print]. PMID: 28544539. [Link]

Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Jachno K, Ward B, Williams A, Baylis A, Crowe L, Oakley E, Dalziel SR; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet. 2017 Apr 11. pii: S0140-6736(17)30555-X. doi: 10.1016/S0140-6736(17)30555-X. PMID: 28410792 [Link]

Long E., Oakley E., Duke T., Babl FE., On behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT). The Clinical Utility of Respiratory Variation in Inferior Vena Cava Diameter for Predicting Fluid Responsiveness in Spontaneously Ventilating Patients. Shock. 2017 Jul 19. doi:10.1097/SHK.0000000000000951 [Epub ahead of print] PMID: 28727606.

Hoeppner T., Borland M., Babl FE., Neutze J., Phillips N., Krieser D., Dalziel SR., Davidson A., Donath S., Jachno K South M., Williams A., Zhang G., Oakley E., Paediatric Research in Emergency Departments International Collaborative (PREDICT). Influence of weather on incidence of bronchiolitis in Australia and New Zealand. J Paediatr Child Health. 2017 Jul 20. doi: 10.1111/jpc.13614. [Epub ahead of print]  PMID: 28727197. [Link]

Deane HC, Wilson CL, Babl FE, Dalziel SR, Cheek JA, Craig SS, Oakley E, Borland M, Cheng NG, Zhang M, Cotterell E, Schuster T, Krieser D, on behalf of the PREDICT Research Network. PREDICT prioritisation study: establishing the research priorities of paediatric emergency medicine physicians in Australia and New Zealand. Emerg Med J.  Published Online First: 30 August 2017. doi: 10.1136/emermed-2017-206727 PMID: 28855237 [Link]

Hoysted C, Babl FE, Kassam-Adams N, Landolt MA, Jobson L, Curtis S, Kharbanda AB, Lyttle MD, Parri N, Stanley R, Alisic E. Perspectives of hospital emergency department staff on trauma-informed care for injured children: An Australian and New Zealand analysis. J Paediatr Child Health. 2017 Aug 6. doi: 10.1111/jpc.13644. PMID: 28782226 [Link]

2017 Presentations (conference proceedings, posters, published abstracts)

Babl FE., Borland ML., Phillips N., Kochar A., Dalton S., Cheek JA., Gilhotra Y., Furyk J., Neutze J., Bressan S., Donath S., Molesworth C., Crowe L., Hearps S., Arpone M., Oakley E., Dalziel SR., Lyttle MD. “Accuracy of NEXUS II head injury decision rule in children,  A PREDICT prospective cohort study.” RCPCH 2017 Annual Conference held in Birmingham from 24 – 26 May 2017. More information

Aims: Clinical decision rules (CDRs) can be applied in Emergency Departments (EDs) to optimise the use of computed tomography (CT) in children with head trauma. The national Emergency X-Radiography utilization Study II (NEXUS II) CDR, as amended for children, has not been externally validated in a large paediatric cohort.  The objective of the study was to conduct a multicentre external validation of NEXUS II CDR in children.
Methods: We performed a prospective observational study of patients < 18 years presenting with head trauma of any severity to 10 Australian/New Zealand EDs.  In a planned secondary analysis we assessed the performance of the NEXUS II CDR for its diagnostic accuracy (with 95% confidence intervals CI) of clinical important intracranial injury (ICI) as identified in CT scans performed in ED.
Results: Of 20,137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1962 (9.8%), of whom 377 (19.2%) had a clinically important ICI as defined by NEXUS II. 74 (19.6%) patients underwent neurosurgery.  Sensitivity for clinically important ICI based on the NEXUS II CDR was 373/377 (98.9%; 97.3%-99.7%) and specificity 156/1585 (9.8%; 8.4%-11.4%). Positive and negative predictive values were respectively 373/1802 (20.7%; 18.8%-22.6%) and 156/160 (97.5%; 93.7%-99.3%). Of the 18,147 children without CT 49.5% had at least one NEXUS II risk criterion.
Conclusion: NEXUS II had very high sensitivity when analysed with a focus on head injured patient who had a CT performed, similar to the derivation study. With half of unimaged patients positive for NEXUS II risk criteria the use of this rule has the potential to increase the number of CTs.

Lyttle MD., Borland ML., Phillips N., Kochar A., Dalton S., Cheek JA., Gilhotra Y., Furyk J., Neutze J., Bressan S., Donath S., Molesworth C., Crowe L., Oakley., Dalziel SR., Babl FE. Accuracy of Physician Practice as compared to PECARN, CATCH and CHALICE head injury decision rules in children. A PREDICT prospective cohort study. RCPCH 2017 Annual Conference held in Birmingham from 24 – 26 May 2017, Arch Dis Child 2017 102: A107-A108 doi: 10.1136/archdischild-2017-313087.267. More information

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. In addition to rule accuracy, however, among a number of factors physician accuracy is also important when determining whether a particular rule should be implemented.  The objective of the study was to assess the 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 <24h) and assessed physician accuracy for the standardised outcome of clinically important traumatic brain injury (ciTBI) and compared this with the accuracy of PECARN, CATCH and CHALICE. Physician accuracy was defined as CT obtained during the initial ED visit.
Results: Of 20,137 children, 18,913 had a mild HI as defined. Of these 1,578 (8.3% = actual CT rate) received a CT scan during the ED visit, 160 (0.8%) had ciTBI and 24 (0.1%) underwent neurosurgery. Physician practice for detecting ciTBI based on CT 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 was 8.0%/9.4% (high risk only) to 41.4%/48.5% (high and intermediate risk, considering the unlikely scenario that all patients in the intermediate risk group receive a CT scan), CATCH 30.2% (medium and high risk) and CHALICE 22.0%.
Conclusions: Physician accuracy was high. The application 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.

Crowe L., Lyttle MD., Hearps S., Anderson V., Borland ML, Phillips N, Kochar A, Dalton S., Cheek JA., Gilhotra Y., Furyk J., Neutze J., Bressan S., Donath S., Molesworth C., Oakley, E. Dalziel SR., Babl FE. Defining mild traumatic brain injury: how classification differs across studies when applied to a large prospective data set. A PREDICT prospective cohort study. RCPCH 2017 Annual Conference held in Birmingham from 24 – 26 May 2017. More information

Aims:Mild traumatic brain injury (TBI) in children is a major public health issue.  Yet there is a wide variation in the way “mild” TBI is defined in literature and guidelines. To date, no study has prospectively detailed the proportion of children presenting with mild TBI to emergency departments (EDs) that are identified by the various definitions.  The objective of the study was to apply published definitions of mild TBI to a large prospectively collected data set of head injuries and to determine the proportions of mild head injuries included by various definitions.
Methods:Prospective observational study of children with HIs of any severity at 10 Australian/New Zealand centres. We applied 18 different definitions of mild TBI, identified through a systematic review of the literature, to children aged 3 to 16 years. We assessed the number and percentage of cases the definitions applied using described inclusion and exclusion criteria.
Results:Of 20,137 children with HI of any severity, 11,907 were aged 3 to 16 years. Mean age was 8.2 years, 32% were female. 61.9% were fall related. Cranial CT rate was 12.7% and neurosurgery rate was 0.5%.  Adjustments were made to the definitions to apply to the data set: none in 7, minor in 9, substantial in 2. Percentages of the cohort covered by the definitions of “mild” TBI ranged from 2.4% (284) to 98.7% (11,756) of the cohort. The median percentage of definitions among 18 definitions investigated was 21.7% (2,589).
Conclusions:When applying different definitions of mild TBI to a single data set including all severities, a wide range of cases are included. Clinicians and researchers need to be aware of this important variability when attempting to apply the published literature to children presenting to EDs with TBI in the Australian and New Zealand setting.

Pfeiffer H., Hearps S., Babl FE., Borland ML., Phillips N., Kochar A., Dalton S., Cheek J., Gilhotra Y., Furyk J., Neutze J., Dalziel S., Lyttle M., Bressan S., Donath S., Molesworth C., Baylis A., Oakley E., Crowe L. Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study. 12th World Congress on Brain Injury held in New Orleans, Louisiana from 29 March – 1 April 2017. Arch Dis Child 2017 102: A117 doi: 10.1136/archdischild-2017-31087.291.More information

Background: While the majority of head injuries in children are non intentional, there is limited information on intentional injuries outside abusive head trauma.
Objective: To investigate intentional head injuries in terms of demographics, epidemiology, and severity.
Methods: Planned secondary analysis of prospective multicentre cohort study of children aged <18 years across 10 centres in Australia and new Zealand.  Victorian state epidemiology codes (intent, activity, place, mechanism) were used to prospectively code the injuries. Data were descriptively analysed.
Results: Intentional injuries were found in 441 of 20,137 (2.2%) head injured children.  Injuries were caused by peers (166, 37.6%), by caregiver (103, 23.4%), by sibling (47, 10.7%), due to attack by stranger (35, 7.9%), attack by person with unknown relation to patient (19, 4.3%), intentional self-harm (7, 1.6%), other cause or undetermined (64, 28.2%).  Children were <2 years old in 75.7% injuries caused by caregivers and 8.3% in other causes.  Overall, 71.0% of victims were male.  Admission rates varied from 77.7% for assault by caregiver, 37.1% attack by stranger, 22.3% by peer and 8.5% by sibling.  Peer assaults were related to sports in 69 cases (41.6%), with highest frequency in contact sports, rugby (40.6%) and Australian football (26.1%).
Conclusion: Intentional head injuries are infrequent in children. The most frequent cause is peer assault, often during sports, and injuries caused by caregivers.

Pfeiffer H., Hearps S., Babl FE., Borland ML., Phillips N., Kochar A., Dalton S., Cheek J., Gilhotra Y., Furyk J., Neutze J., Dalziel S., Lyttle M., Bressan S., Donath S., Molesworth C., Baylis A., Oakley E., Crowe L. Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study. 12th World Congress on Brain Injury held in New Orleans, Louisiana from 29 March – 1 April 2017. More information

Background: Abusive head trauma (AHT) is associated with high morbidity and mortality.  It may be difficult to detect in the emergency department (ED).
Objective: To determine how cases of suspected AHT differ from non abusive head injuries in the ED setting.
Methods: Planned secondary analysis of prospective multicentre cohort study of children aged <18 years across 10 centres in Australia and new Zealand with head injuries.  We identified cases of suspected AHT when ED clinicians identified such suspicion on a clinical report form or based on research assistant assigned epidemiology codes.  We compared suspected AHT cases and non AHT cases using risk ratios with 95% CIs.  We assessed the rate of clinically important traumatic brain injuries (ciTBI: death; neurosurgery; intubation >1 day, admission >2 days with abnormal CT scan).
Results: AHT was suspected in 103 of 20,137 (0.5%) head injured children.  Mean age was 2.4 years (SD 4.0). GCS was <12 in 9 (8.7%), 12 (11.7%) presented with seizures, 71 (68.9%) underwent CT head, of which 49 (69%) were abnormal.  80 (77.7%) children were admitted.  Neurosurgery was performed in 3 and 2 children died.  23 (22.3%) had ciTBI.  RR (95% CI) for AHT vs non AHT were: LOC 1.4 (0.7-2.7), vomiting 1.6 (1.202.2), scalp haematoma 2.3 (2.0-2.6), GCS <12 8.5 (4.5-16.0), abnormal neuroimaging 16.4 (13.2-20.4), neurosurgery 7.4 (2.4-22.9), mortality 29.9 (6.8-130.9), ciTBI 17.4 (6.8-25.5).
Conclusion: In the ED clinical presentation in children with suspected AHT differ from non AHT cases.  Suspected cases of AHT are at increased risk of abnormal CT scans, ciTBI and death.

Pfeiffer H.S, Smith A., Cheek JA., Oakley E., Crowe L., Hearps S., Lyttle MD., Bressan S., Babl FE., Emergency Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia, Dalziel SR., Borland ML., Bonisch M., O’Brien S., Neutze J., Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia, Kemp AM., Cowley L., Cardiff University, Cardiff, United Kingdom. External Validation of the PediBIRN Clinical Prediction Rule for Paediatric Abusive Head Trauma. A PREDICT study.  PAS held in San Francisco, California from 6-9 May 2017 More information

Background: Missing cases of abusive head trauma (AHT) can have severe consequences for affected children. Therefore a 4-variable AHT clinical prediction rule (CPR) for use in the Paediatric Intensive Care Unit (PICU) has been derived and validated for children <3 years by the Pediatric Brain Injury Research Network (PediBIRN).
Objective: We set out to externally validate the CPR applying the tool as designed (PICU only) as well as using broader inclusion criteria (all admitted children with HI).
Methods: In a planned secondary analysis of a prospective multicentre study of paediatric head injuries (HI) of any severity, we extracted patients at 3 tertiary paediatric centres who were either 1) prospectively identified by clinician suspicion for NAI, 2) had epidemiology codes for NAI assigned by a research assistant or 3) were part of a high-risk group (age < 3 years, admitted, abnormal neuroimaging). At one centre we also extracted HI cases from the forensic data base. Based on medical records we assigned all potential AHT cases as AHT positive, negative or indeterminate based on multidisciplinary review and applied PediBIRN criteria 1) as published (PICU only) and 2) using broader inclusion criteria (any admission).
Results: Medical records of 157 possible AHT cases were reviewed. 83.4% were aged less than 2 years, 59.2% were male, 75.8% had an abnormal CT scan and 3.2% died due to head injury. Out of these, 121 had cranial or intracranial injuries confirmed by neuroimaging and were categorized as AHT positive in 30 cases (24.8%), AHT indeterminate in 18 cases (14.9%) and AHT negative in 73 cases (60.3%) based on the decision of a multidisciplinary child protection team. 26 cases met the original inclusion criteria and using the tool as designed, it detected 12 out of 12 AHT positive cases (sensitivity = 100.0% (70.0% û 100.0%)) and correctly categorized 1 out of 8 AHT negative cases (specificity = 12.5% (0.6% û 53.3%)). Using broader inclusion criteria of admitted patients, 117 cases were included and the CPR demonstrated a sensitivity of 27/28 (96.4% (80.0% û 99.8%)) and a specificity of 31/71 (43.7% (32.1% û 55.9%)).
Conclusion: The 4-variable AHT CPR derived and validated by the PediBIRN investigators demonstrated high sensitivity using the tool as designed for PICU patients as well as in a broader group of admitted patients.

Babl FE., Emergency Department, Royal Children’s Hospital, Melbourne, Victoria, Australia, Donath S., Molesworth C., Crowe L., Hearps S., Arpone M., Emergency Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia, Borland ML., Phillips N., Kochar A., Dalton S., Cheek JA., Gilhotra Y., Furyk J., Neutze J., Lyttle MD., Bressan S., Oakley E., Dalziel SR., Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia. Accuracy of NEXUS II head injury decision rule in children. A PREDICT prospective cohort study. PAS held in San Francisco, California from 6-9 May 2017 More information

Background: Clinical decision rules (CDRs) can be applied in Emergency Departments (EDs) to optimise the use of computed tomography (CT) in children with head trauma. The National Emergency X-Radiography Utilization Study II (NEXUS II) CDR, as amended for children, has not been externally validated in a large pediatric cohort
Objective: To conduct a multicentre external validation of NEXUS II CDR in children.
Methods: We performed a prospective observational study of patients < 18 years presenting with head trauma of any severity to 10 Australian/New Zealand EDs. In a planned secondary analysis we assessed the performance of the NEXUS II CDR for its diagnostic accuracy (with 95% confidence intervals CI) of clinical important intracranial injury (ICI) as identified in CT scans performed in ED.
Results: Of 20,137 total patients, we excluded 28 with suspected penetrating injury. Median age was 4.2 years. CTs were obtained in ED for 1,962 (9.8%), of whom 377 (19.2%) had a clinically important ICI as defined by NEXUS II. 74 (19.6%) patients underwent neurosurgery. Sensitivity for clinically important ICI based on the NEXUS II CDR was 373/377 (98.9%; 97.3%-99.7%) and specificity 156/1585 (9.8%; 8.4%-11.4%). Positive and negative predictive values were respectively 373/1802 (20.7%; 18.8%-22.6%) and 156/160 (97.5%; 93.7%-99.3%). Of the 18,147 children without CT 49.5% had at least one NEXUS II risk criterion.
Conclusion: NEXUS II had very high sensitivity when analysed with a focus on head injured patients who had a CT performed, similar to the derivation study. With half of unimaged patients positive for NEXUS II risk criteria the use of this rule has the potential to increase the number of CTs.

Crowe L., Hearps S., Molesworth C., Oakley E., Anderson V., Babl FE., Emergency Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia, Cheek JA., Emergency Department, Royal Children’s Hospital, Melbourne, Victoria, Australia, Neutze J., Furyk J., Gilhotra Y., Dalton S., Kochar A., Phillips N., Lyttle MD., Bressan S., Donath S., Dalziel SR., Borland ML., Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia. Defining mild traumatic brain injury: how classification differs across studies when applied to a large prospective data set. A PREDICT prospective cohort study. PAS held in San Francisco, California from 6-9 May 2017 More information

Background: Mild traumatic brain injuries (TBI) in children are a major public health issue. Yet, there is a wide variation in the way ômildö TBI is defined in literature and guidelines. To date, no study has prospectively detailed the proportion of children presenting with mild TBI to emergency departments (EDs) that are identified by the various definitions.
Objective: To apply published definitions of mild TBI to a large prospectively collected data set of head injuries and to determine the proportions of mild head injuries included by various definitions.
Methods: Prospective observational study of children with HIs of any severity at 10 Australian/New Zealand centres. We applied 18 different definitions of mild TBI, identified through a systematic review of the literature, to children aged 3 to 16 years. We assessed the number and percentage of cases the definitions applied using described inclusion and exclusion criteria
Results: Of 20,137 children with HI of any severity, 11,907 were aged 3 to 16 years. Mean age was 8.2 years, 32% were female. 61.9% were fall related. Cranial CT rate was 12.7% and neurosurgery rate was 0.5%. Adjustment were made to the definitions to apply to the data set: none in 7, minor in 9, substantial in 2. Percentages of the cohort covered by the definitions of ômildö TBI ranged from 2.4% (284) to 98.7% (11,756) of the cohort. The median percentage of head injuries defined as mild among 18 definitions investigated was 21.7% (2,589).
Conclusion: When applying different definitions of mild TBI to a single data set including all severities, a wide range of cases were included. Clinicians and researchers need to be aware of this important variability when attempting to apply the published literature to children presenting to EDs with TBI.

Babl FE., Molesworth C., Crowe L., Oakley E., Emergency Research, Murdoch Children’s Research Institute, Parkville, Victoria, Australia, Cheek JA., Emergency Department, Royal Children’s Hospital, Melbourne, Victoria, Australia, Phillips N., Kochar A., Dalton S., Gilhotra Y., Furyk J., Neutze J., Lyttle MD., Bressan S., Donath S., Dalziel SR., Borland ML., Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia. Accuracy of Physician Practice as compared to PECARN, CATCH and CHALICE head injury decision rules in children. A PREDICT prospective cohort study. PAS held in San Francisco, California from 6-9 May 2017 More information

Background: 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. In addition to rule accuracy, however, among a number of factors physician accuracy is also important when determining whether a particular rule should be implemented.
Objective: To assess the 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 <24h) and assessed physician accuracy for the standardised outcome of clinically important traumatic brain injury (ciTBI) and compared this with the accuracy of PECARN, CATCH and CHALICE. Physician accuracy was defined as CT obtained during the initial ED visit.
Results: Of 20,137 children, 18,913 had a mild HI as defined with a median age of 4.1 years. Of these 1,578 (8.3% = actual CT rate) received a CT scan during the ED visit, 160 (0.8%) had ciTBI and 24 (0.1%) underwent neurosurgery. Physician practice for detecting ciTBI based on CT 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 was 8.0%/9.4% (high risk only) to 41.4%/48.5% (high and intermediate risk, considering the unlikely scenario that all patients in the intermediate risk group receive a CT scan), CATCH 30.2% (medium and high risk) and CHALICE 22.0%.
Conclusion: Physician accuracy was high. The application 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.