Paediatric Head Injury – To CT or not CT? Slides taken from: Advanced Paediatric Life Support Presentation created and presented by: Dr Setthy Ung APLS Australia Course Director

Head Injury – To CT or not CT? Babl et al. Lancet 2017 0-18yrs, <24hrs, 18,913 patients PREDICT EDs across Australia For clinically important Traumatic Brain Injury PECARN < 2yrs - Sens 100% Spec 59.1% > 2yrs - Sens 99.2% Spec 52% CATCH - Sens 91.9% Spec 70.4% CHALICE – Sens 92.5% Spec 78.6%

PECARN < 2yrs High Risk (4.3%) indicating CT scanning GCS 14 Or other signs of altered mental status Or Palpable skull fracture (<2yrs) Lower Risk (0.9%) to then consider observation over CT scanning Scalp haematoma (occipital, temporal or parietal) Loss of consciousness > 5secs Severe mechanism of injury Not acting normally according to parent All above negative gave < 0.02% risk Other clinical factors: Physician experience Multiple concomitant factors Worsening signs and symptoms Parental Preference

PECARN > 2yrs High Risk (4.4%) indicating CT scanning GCS 14 Or other Signs of altered mental status Or Signs of Base of Skull fracture Lower Risk (0.8%) to then consider observation over CT scanning History of LOC History of vomiting Severe mechanism of injury Severe headache All above negative gave < 0.05% risk Other clinical factors: Physician experience Multiple concomitant factors Worsening signs and symptoms Parental Preference