Article Figures & Data
Figures
- FIGURE.
The Think A-Head campaign poster (www.imagegently.org). Poster design courtesy of the American Society of Radiologic Technologists.
Tables
- Table 1:
Decision rule comparison of predictor variables, modified after Lyttle et al16,18–20
PECARN CATCH CHALICE Mechanism of injury Severe mechanism of injury (MVC with patient ejection, death of another passenger, or rollover; pedestrian/bicyclist without helmet struck by motorized vehicle; falls >1.5 m [if younger than 2 yr, fall >0.9 m]; head struck by high-impact object) Dangerous mechanism of injury (eg, MVC; fall from elevation of ≥3 feet [≥0.91 m] or 5 stairs; fall from bicycle with no helmet). High-speed road traffic collision: pedestrian, cyclist, occupant (>40 miles/h or 64 km/h); fall >3 m in height; high-speed injury from projectile or object History Any or suspected LOC History of worsening headache Witnessed LOC >5 min History of vomiting ≥3 Vomits after head injury (discrete episodes) If age younger than 2 years Amnesia (anterograde/retrograde >5 min) LOC ≥5 sec Suspicion of nonaccidental injury Not acting normally per parent Seizure in patient with no history of epilepsy Physical examination Clinical signs of basilar skull fracture GCS < 15, two hours after injury GCS < 14, pediatric GCS < 15 if younger than 1 yr of age If younger than 2 years age: Irritability on examination Abnormal drowsiness (more than that expected by examining doctor) Palpable or unclear skull fracture Any sign of basal skull fracture Positive focal neurology Occipital, parietal, or temporal scalp hematoma Suspected open or depressed skull fracture Signs of basal skull fracture Large boggy scalp hematoma Suspicion of penetrating or depressed skull injury or tense fontanelle
Presence of bruise/swelling/laceration >5 cm if younger than 1 yr of ageNote:—MVC indicates motor vehicle collision; LOC, loss of consciousness.
Decision Rule Sensitivity (95% CI) Specificity (95% CI) Reference CATCH 98.1% (94.6%–99.4%) 50.1% (48.5%–51.7%) Osmond et al 201019 CHALICE 98% (96%–100%) 87% (86%–87%) Dunning et al 200620 PECARN 100% (84%–100%) 62% (59%–66%) Babl et al 201415 NPV = 99.95%–100% Kuppermann et al 200916 Mihindu et al 201417 Note:—NPV indicates negative predictive value.
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