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 age |
Note:—MVC indicates motor vehicle collision; LOC, loss of consciousness.