Evaluation of Computed Tomography Decision-Making in Pediatric Minor Head Trauma: PECARN, CATCH, AND CHALICE

Abstract

Aim: This study aimed to evaluate the appropriateness of computed tomography (CT) indications according to the Pediatric Emergency Care Applied Research Network (PECARN), the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), and the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) clinical decision rules in pediatric patients presenting to the emergency department with minor head trauma for whom neurosurgical consultation was requested, and to compare the diagnostic performance of these rules. Method: In this retrospective study, a total of 104 pediatric patients aged 0–18 years, with a Glasgow Coma Scale (GCS) score of 13–15, who presented to the emergency department between October 1, 2024 and September 30, 2025 and for whom neurosurgical consultation was requested, were evaluated. Cranial computed tomography was performed in all patients. Taking CT findings as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of the PECARN, CATCH, and CHALICE clinical decision rules were calculated. Results: Abnormal CT findings were detected in 27 of 104 patients (26.0%). The sensitivities of the PECARN, CATCH, and CHALICE rules were 70.4%, 66.7%, and 63.0%, respectively, whereas their specificities were 50.6%, 59.7%, and 72.7%, respectively. PECARN showed the highest sensitivity, while CHALICE demonstrated the highest specificity. No abnormal CT findings were identified in 74.0% of the patients. Conclusion: The PECARN, CATCH, and CHALICE clinical decision rules are useful tools for guiding CT use in pediatric minor head trauma. PECARN prioritizes patient safety with its higher sensitivity, whereas CHALICE offers a more selective approach for reducing unnecessary imaging with its higher specificity. Appropriate use of these clinical decision rules may help reduce unnecessary radiation exposure; however, they should be applied in conjunction with clinical evaluation during the decision-making process.

Keywords

• Computed tomography
• Head trauma
• Minor trauma
• Pediatric

Ethical Statement

The study was conducted with the approval of the Ordu University Ethics Committee (Decision No: 2025/362-BAEK-385; Date: October 31, 2025).

Çocuklarda Hafif Kafa Travmalarında Bilgisayarlı Tomografi Kararının Değerlendirilmesi: PECARN, CATCH ve CHALICE

Abstract

Amaç: Bu çalışmada, pediatrik minör kafa travması ile acil servise başvuran ve nöroşirürji konsültasyonu istenen hastalarda, PECARN, CATCH ve CHALICE klinik karar kurallarına göre bilgisayarlı tomografi (BT) çekim endikasyonunun uygunluğunun değerlendirilmesi ve bu kuralların tanısal performanslarının karşılaştırılması amaçlandı. Yöntem: Bu retrospektif çalışmada, 01 Ekim 2024 – 30 Eylül 2025 tarihleri arasında acil servise başvuran, 0–18 yaş aralığında, GKS skoru 13–15 olan ve nöroşirürji konsültasyonu istenen toplam 104 pediatrik hasta değerlendirildi. Tüm hastalara kraniyal BT çekildi. BT bulguları altın standart olarak kabul edilerek, PECARN, CATCH ve CHALICE klinik karar kurallarının duyarlılık, özgüllük, pozitif ve negatif prediktif değerleri hesaplandı. Bulgular: Toplam 104 hastanın 27’sinde (%26) patolojik BT bulgusu saptandı. PECARN, CATCH ve CHALICE kurallarının duyarlılıkları sırasıyla %70,4, %66,7 ve %63,0; özgüllükleri ise %50,6, %59,7 ve %72,7 olarak bulundu. PECARN kuralı en yüksek duyarlılığa sahipken, CHALICE kuralı en yüksek özgüllüğü göstermiştir. Hastaların %74’ünde BT’de patolojik bulgu saptanmamıştır. Sonuç: PECARN, CATCH ve CHALICE klinik karar kuralları pediatrik minör kafa travmalarında BT kullanımını yönlendirmede etkili araçlardır. PECARN daha yüksek duyarlılık ile hasta güvenliğini ön planda tutarken, CHALICE gereksiz görüntülemeyi azaltmada daha seçici bir yaklaşım sunmaktadır. Klinik karar kurallarının uygun kullanımı gereksiz radyasyon maruziyetini azaltabilir; ancak karar sürecinde klinik değerlendirme ile birlikte kullanılmaları gereklidir.

Keywords

• Bilgisayarlı tomografi
• Kafa travması
• Minör travma
• Pediatri

Ethical Statement

Çalışma, Ordu Üniversitesi Etik Kurulu'nun onayıyla gerçekleştirilmiştir (Karar No: 2025/362-BAEK-385; Tarih: 31 Ekim 2025).

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