A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): the Australasian Paediatric Head Injury Rules Study (APHIRST)

BMC Pediatrics

Ed Oakley⁸  Amanda Williams⁸  Louise Crowe⁸  Kim Jachno⁸  Susan Donath⁸  Brenton Ward^1,10  Jocelyn Neutze^1,11  Yuri Gilhotra⁹  Jeremy Furyk^1,13  John A Cheek^1,10  Sarah Dalton¹  Stuart R Dalziel⁶  Amit Kochar³  Natalie Phillips⁵  Meredith Borland⁴  Silvia Bressan^1,12  Mark D Lyttle²  Franz E Babl⁷ 

[1] The Children’s Hospital at Westmead, Sydney, Australia;Academic Department of Emergency Care, University of the West of England, Bristol, UK;Women’s & Children’s Hospital, Adelaide, Australia;Princess Margaret Hospital for Children, Perth, Australia;Royal Children's Hospital and Queensland Children's Medical Research Institute, Queensland University, Brisbane, Australia;Liggins Institute, University of Auckland, Auckland, New Zealand;National Trauma Research Institute, Prahan, VIC, Australia;Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne VIC 3010, Australia;Mater Children’s Hospital, Brisbane, Australia;Murdoch Childrens Research Institute, Parkville, VIC, Australia;Kidzfirst Middlemore Hospital, Auckland, New Zealand;University of Padova, Padova, Italy;Townsville Hospital, Townsville, Australia

关键词: Validation;    Computed tomography;    Clinical decision rule;    Head injury;   

Others  :  1138774
DOI  :  10.1186/1471-2431-14-148

 received in 2014-05-04, accepted in 2014-05-27,  发布年份 2014

【 摘 要 】

Background

Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting.

Methods/design

This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria.

Discussion

This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting.

Trial registration

The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)-ACTRN12614000463673 (registered 2 May 2014).

【 授权许可】

   
2014 Babl et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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