APHIRST

Australian Paediatric Head Injury Rules Study

This study aims to determine which of three existing clinical decision rules for the management of paediatric head injuries (CATCH, CHALICE & PECARN), can best be applied to the Australasian population to improve current emergency department patient care through (i) more accurately identifying those children who have clinically significant intracranial injuries and (ii) reducing the number of unnecessary brain CT scans.

Study design

Prospective observational study

Project Status

Completed

Project Category

Trauma and Injury

Chief Investigators

Franz Babl

Time frame

2011 – 2015

Funding

Emergency Medicine Foundation
Murdoch Childrens Research Institute
Auckland Medical Research Foundation
A+ Trust, Auckland District Health Board, Auckland, New Zealand
Townsville Hospital and Health Service Private Practice Research and Education Trust fund
WA Health Targeted Research Fund
National Health and Medical Research Council

Sample

20,000 children aged 0 – 18 years, diagnosed with head injury

Contact

Franz.babl@rch.org.au

Publications to date

Babl FE, Bressan S. Imaging rules in paediatric trauma: The PECARN decision rules for head, neck and abdominal trauma. Arch Dis Child. doi: 10.1136/archdischild-2024-327822. EPub 2024 Sept 5.

Singh S, Hearps S, Nishijima DK, Cheek JA, Borland M, Dalziel S, Holmes J, Kuppermann N, Babl FE, Hoch JS; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Cost-effectiveness of patient observation on cranial CT use with minor head trauma. Arch Dis Child. 2022 Aug;107(8):712-718. doi: 10.1136/archdischild-2021-323701. Epub 2022 Feb 22. PMID: 35193874. [Link]

Eapen N, Kochar A, Lyttle MD, Phillips N, Cheek JA, Furyk J, Neutze J, Bressan S, Williams A, Hearps S, Oakley E, Dalziel SR, Borland ML, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Seizure- and syncope-related head injuries in children: A prospective PREDICT cohort study. Emerg Med Australas. 2021 Jun 8. doi: 10.1111/1742-6723.13812. Online ahead of print. PMID: 34105253. [link]

Babl FE, Rausa VC, Borland ML, Kochar A, Lyttle MD, Phillips N, Gilhotra Y, Dalton S, Cheek JA, Furyk J, Neutze J, Bressan S, Davis GA, Anderson V, Williams A, Oakley E, Dalziel SR, Crowe LM, Hearps SJC. Characteristics of concussion based on patient age and sex: a multicenter prospective observational study. J Neurosurg Pediatr. 2021 Oct 1:1-10. doi: 10.3171/2021.6.PEDS20953. Epub ahead of print. PMID: 34598158. [Link].

Singh S, Babl FE, Hearps SJC, Hoch JS, Dalziel K, Cheek JA. Trends of paediatric head injury and acute care costs in Australia. J Paediatr Child Health. 2021 Sep 15. doi: 10.1111/jpc.15699. Epub ahead of print. PMID: 34523175. [link].

Bressan S, Monagle P, Dalziel SR, Borland ML, Phillips N, Kochar A, Lyttle MD, Cheek JA, Neutze J, Oakley E, Dalton S, Gilhotra Y, Hearps S, Furyk J, Babl FE; (PREDICT). Risk of traumatic intracranial haemorrhage in children with bleeding disorders. J Paediatr Child Health. 2020 Aug 18. doi: 10.1111/jpc.15073. Online ahead of print. PMID: 32810331. [link].

Babl FE, Lyttle MD, Phillips N, Kochar A, Dalton S, Cheek JA, Furyk J, Neutze J, Bressan S, Williams A, Hearps SJC; MBiostat, Oakley E, Davis GA, Dalziel SR, Borland ML. Mild traumatic brain injury in children with ventricular shunts: a PREDICT study. J Neurosurg Pediatr. 2020 Nov 20:1-7. doi: 10.3171/2020.7.PEDS2090. [Epub ahead of print]. PMID: 33254139. [link]

Pfeiffer H, Cowley LE, Kemp AM, Dalziel SR, Smith A, Cheek JA, Borland ML, O’Brien S, Bonisch M, Neutze J, Oakley E1, Crowe LM, Hearps S, Lyttle MD, Bressan S, Babl FE. Validation of the PredAHT-2 prediction tool for abusive head trauma. Emerg Med J. 2020 Jan 13. pii: emermed-2019-208893. doi: 10.1136/emermed-2019-208893. E-pub ahead of print. [link].

Kochar A, Borland ML, Phillips N, Dalton S, Cheek JA, Furyk J, Neutze J, Lyttle MD, Hearps S, Dalziel S, Bressan S, Oakley E, Babl FE. Association of clinically important traumatic brain injury and Glasgow Coma Scale scores in children with head injury. Emerg Med J. 2020 Feb 12. pii: emermed-2018-208154. [Epub ahead of print] [link].

Singh S, Hearps SJC, Borland ML, Dalziel SR, Neutze J, Donath S, Cheek JA, Kochar A, Gilhotra Y, Phillips N, Williams A, Lyttle MD, Bressan S, Hoch JS, Oakley E, Holmes JF, Kuppermann N, Babl FE; (PREDICT). The Effect of Patient Observation on Cranial Computed Tomography Rates in Children with Minor Head Trauma. Acad Emerg Med. 2020 Feb 16. doi: 10.1111/acem.13942. [Epub ahead of print]. [Link]

Bressan S, Clarke CJ, Anderson V, Takagi M, Hearps SJC, Rausa V, Anderson N, Doyle M, Dunne K, Oakley E, Davis GA, Babl FE. Use of the sport concussion assessment tools in the emergency department to predict persistent post-concussive symptoms in children. J Paediatr Child Health. 2020 May 21. doi: 10.1111/jpc.14910. Online ahead of print. PMID: 32436608 [link].

Borland ML, Dalziel SR, Phillips N, Lyttle MD, Bressan S, Oakley E, Hearps SJC, Kochar A, Furyk J, Cheek JA, Neutze J, Gilhotra Y, Dalton S, Babl FE; (PREDICT) Group. Delayed Presentations to Emergency Departments of Children With Head Injury: A PREDICT Study, Ann Emerg Med. 2019 July, 74(1) pii: S0196-0644(18)31485-9. doi: 10.1016/j.annemergmed.2018.11.035. [link]

Shavit I, Rimon A, Waisman Y, Borland ML, Phillips N, Kochar A, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Dalziel SR, Lyttle MD, Bressan S, Donath S, Hearps S, Oakley E, Crowe L, Babl FE; (PREDICT). Performance of Two Head Injury Decision Rules Evaluated on an External Cohort of 18,913 Children. J Surg Res. 2019 Aug 20;245:426-433. doi: 10.1016/j.jss.2019.07.090. [Epub ahead of print] [link

Babl FE, Cheek J, Dalziel K, Bressan S, Dalziel S. on behalf of PREDICT. In Reply to Mower LTE 2019-864: Clinical Judgment and the Clinical Decision Rules. Annals Emergency Medicine. Dec 2019; 74(6): 821-823. https://doi.org/10.1016/j.annemergmed.2019.06.006. [Epub ahead of print] [link].

Eapen N, Davis GA, Borland ML, Phillips N, Oakley E, Hearps S, Kochar A, Dalton S, Cheek J, Furyk J, Lyttle D, Bressan S, Crowe L, Dalziel S, Tavender E, Babl FE. Clinically important sport-related traumatic brain injuries in children. Med J Aust. 2019 Aug 16. doi: 10.5694/mja2.50311. [Epub ahead of print] [link].

Babl FE, Pfeiffer H, Kelly P, Dalziel SR, Oakley E, Borland ML, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Lyttle MD, Bressan S, Donath S, Hearps SJC, Smith A, Crowe L; (PREDICT). Paediatric abusive head trauma in the emergency department: A multicentre prospective cohort study. J Paediatr Child Health. 2019 Dec 10. doi: 10.1111/jpc.14700. [Epub ahead of print] [link].

Eapen N, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Neutze J, Lyttle MD, Donath S, Crowe L, Dalziel SR, Oakley E, Williams A, Hearps S, Bressan S, Babl FE. Neonatal head injuries: A prospective Paediatric Research in Emergency Departments International Collaborative cohort study. J Paediatr Child Health. 2019 Dec 23. doi: 10.1111/jpc.14736. [Epub ahead of print] [link].

Bressan S, Kochar A, Oakley E, Borland M, Phillips N, Dalton S, Lyttle MD, Hearps S, Cheek JA, Furyk J, Neutze J, Dalziel S, Babl FE; (PREDICT) group. Traumatic brain injury in young children with isolated scalp haematoma. Arch Dis Child. 2019 Mar 4. pii: archdischild-2018-316066. doi: 10.1136/archdischild-2018-316066. [Epub ahead of print]. [link].

Phillips N, Dalziel SR, Borland ML, Dalton S, Lyttle MD, Bressan S, Oakley E, Hearps SJ, Kochar A, Furyk J, Cheek JA, Gilhotra Y, Neutze J, Babl FE; (PREDICT) group. Imaging and admission practices in paediatric head injury across emergency departments in Australia and New Zealand: A PREDICT study. Emerg Med Australas. 2019 Nov 26. doi: 10.1111/1742-6723.13396. [Epub ahead of print] [link].

Babl FE, Lyttle MD, Bressan S, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Donath S, Hearps S, Arpone M, Crowe L, Dalziel SR, Barker R, Oakley E. Penetrating head injuries in children presenting to the emergency department in Australia and New Zealand: A PREDICT prospective study. J Paediatr Child Health. 2018 Mar 26. doi: 10.1111/jpc.13903. [Epub ahead of print] PMID: 29579354 [link].

Borland ML, Dalziel SR, Phillips N, Dalton S, Lyttle MD, Bressan S, Oakley E, Hearps SJC, Kochar A, Furyk J, Cheek JA, Neutze J, Babl FE; Paediatric Research in Emergency Department International Collaborative group (PREDICT). Vomiting With Head Trauma and Risk of Traumatic Brain Injury. Pediatrics. 2018 Apr;141(4). pii: e20173123. doi: 10.1542/peds.2017-3123. [link]

Babl FE, Oakley E, Dalziel SR, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Donath S, Hearps S, Crowe LM, Arpone M, Bressan S, Lyttle MD; (PREDICT). Accuracy of NEXUS II head injury decision rule in children: a prospective PREDICT cohort study, Emerg Med J. 2018 Aug 20. pii: emermed-2017-207435. doi: 10.1136/emermed-2017-207435. [Epub ahead of print] PMID: 30144871 [link]

Dalziel K, Cheek JA, Fanning L, Borland ML, Phillips N, Kochar A, Dalton S, Furyk J, Neutze J, Dalziel SR, Lyttle MD, Bressan S, Donath S, Molesworth C, Hearps SJC, Oakley E, Babl FE; (PREDICT). A Cost-Effectiveness Analysis Comparing Clinical Decision Rules PECARN, CATCH, and CHALICE With Usual Care for the Management of Pediatric Head Injury. Ann Emerg Med. 2018 Nov 14. doi: 10.1016/j.annemergmed.2018.09.030. [Epub ahead of print] [link]

Babl FE, Pfeiffer H, Dalziel SR, Oakley E, Anderson V, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Hearps SJ, Crowe L; (PREDICT). Paediatric intentional head injuries in the emergency department: A multicentre prospective cohort study. Emerg Med Australas. 2018 Nov 26. doi: 10.1111/1742-6723.13202. [Epub ahead of print] [link]

Daverio M, Babl FE, Barker R, Gregori D, Da Dalt L, Bressan S, (PREDICT) group. Helmet use in preventing acute concussive symptoms in recreational vehicle related head trauma. Brain Inj., 2018;32(3):335-341. doi:10.1080/02699052.2018.1426107. Epub 2018 Jan 22. [link]

Babl FE, Oakley E, Dalziel SR, Borland ML, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Donath S, Hearps S, Molesworth C, Crowe L, Bressan S, Lyttle MD. Accuracy of Clinician Practice Compared With Three Head Injury Decision Rules in Children: A Prospective Cohort Study. Ann Emerg Med. 2018 Feb 13. pii: S0196-0644(18)30028-3. doi: 10.1016/j.annemergmed.2018.01.015. [Epub ahead of print] [link].

Pfeiffer H, Crowe L, Kemp AM, Cowley LE, Smith AS, Babl FE; Paediatric Research in Emergency Departments International Collaborative (PREDICT). Clinical prediction rules for abusive head trauma: a systematic review. Arch Dis Child. 2018 Apr 5. pii: archdischild-2017-313748. doi: 10.1136/archdischild-2017-313748. [Epub ahead of print] [link]

Pfeiffer H, Smith A, Kemp AM, Cowley LE, Cheek JA, Dalziel SR, Borland ML, O’Brien S, Bonisch M, Neutze J, Oakley E1, Crowe L, Hearps SJC, Lyttle MD, Bressan S, Babl FE; (PREDICT). External Validation of the PediBIRN Clinical Prediction Rule for Abusive Head Trauma. Pediatrics. 2018 May;141(5). pii: e20173674. doi: 10.1542/peds.2017-3674. [link]

Crowe LM, Hearps S, Anderson V, Borland M, Phillips N, Kochar A, Dalton S, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Oakley E, Dalziel SR, Babl FE. Investigating the variability in mild traumatic brain injury definitions: a prospective cohort study. Arch Phys Med Rehabil. 2018 Jan 30. pii: S0003-9993(18)30042-X. doi: 10.1016/j.apmr.2017.12.026. [Epub ahead of print] [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; (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]

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., (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]

Babl FE, Lyttle MD, Bressan S, Borland M, Phillips N, Kochar A, Dalziel SR, Dalton S, Cheek JA, Furyk J, Gilhotra Y, Neutze J, Ward B, Donath S, Jachno K, Crowe L, Williams A, Oakley E; PREDICT research network. A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST). BMC Pediatr. 2014 Jun 13;14:148. doi: 10.1186/1471-2431-14-148. PMID: 24927811; PMCID: PMC4074143. [link]

Lockie F. D., Dalton S., Oakley E., and Babl F. E., ‘Triggers for Head Computed Tomography Following Paediatric Head Injury: Comparison of Physicians’ Reported Practice and Clinical Decision Rules’, Emerg Med Australas, (2013) 25 (1), 75-82. [link]