INTRODUCTION: High performing clinical decision rules (CDRs) have been derived to predict which head-injured @entity1 requires a computed tomography (CT) of the brain. We set out to evaluate the performance of these rules in the Singapore population. MATERIALS AND METHODS: This is a prospective observational cohort study of @entity1 aged less than 16 who presented to the @entity341 ( @entity341 ) from April 2014 to June 2014 with a history of @entity542 . Predictor variables used in the Canadian Assessment of Tomography for @entity542 (CATCH), @entity1 's @entity542 Algorithm for the Prediction of Important Clinical Events (CHALICE) and Pediatric Emergency Care Applied Research Network (PECARN) CDRs were collected. Decisions on CT imaging and disposition were made at the physician's discretion. The performance of the CDRs were assessed and compared to current practices. RESULTS: A total of 1179 @entity1 were included in this study. Twelve (1%) CT scans were ordered; 6 (0.5%) of them had positive findings. The application of the CDRs would have resulted in a significant increase in the number of @entity1 being subjected to CT (as follows): CATCH 237 (20.1%), CHALICE 282 (23.9%), PECARN high- and intermediate-risk 456 (38.7%), PECARN high-risk only 45 (3.8%). The CDRs demonstrated sensitivities of: CATCH 100% (54.1 to 100), CHALICE 83.3% (35.9 to 99.6), PECARN 100% (54.1 to 100), and specificities of: CATCH 80.3% (77.9 to 82.5), CHALICE 76.4% (73.8 to 78.8), PECARN high- and intermediate-risk 61.6% (58.8 to 64.4) and PECARN high-risk only 96.7% (95.5 to 97.6). CONCLUSION: The CDRs demonstrated high accuracy in detecting @entity1 with positive CT findings but direct application in areas with low rates of significant @entity131 ( @entity131 ) is likely to increase unnecessary CT scans ordered. Clinical observation in most cases may be a better alternative.

Clinical Decision Rules for Paediatric XXXX : Are CT Scans a Necessary Evil?

@entity1 :: ('9606', 'Species') :: ['children', 'Children', 'child'] @entity341 :: ('MESH:D004630', 'Disease') :: ['emergency department', 'ED'] @entity542 :: ('MESH:D006259', 'Disease') :: ['Head Injury', 'head injury', 'Childhood Head Injury'] @entity131 :: ('MESH:D001930', 'Disease') :: ['TBI', 'traumatic brain injury']
@entity542 :: (MESH:D006259,Disease) :: ['Minor Head Injury']
