Osmond, M. H., Klassen, T. P., Wells, G. A., Davidson, J., Correll, R., Boutis, K., Joubert, G., Gouin, S., Khangura, S., Turner, T., Belanger, F., Silver, N., Taylor, B., Curran, J., & Stiell, I. G. (2018). Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. CMAJ, 190(27), E816-E822. https://doi.org/10.1503/cmaj.170406
Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. / Osmond, Martin H.; Klassen, Terry P.; Wells, George A. et al.
In:
CMAJ, Vol. 190, No. 27, 09.07.2018, p. E816-E822.
Research output: Contribution to journal › Article › peer-review
Osmond, MH, Klassen, TP, Wells, GA, Davidson, J, Correll, R, Boutis, K, Joubert, G, Gouin, S, Khangura, S, Turner, T, Belanger, F, Silver, N, Taylor, B, Curran, J & Stiell, IG 2018, 'Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department', CMAJ, vol. 190, no. 27, pp. E816-E822. https://doi.org/10.1503/cmaj.170406
Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K et al. Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. CMAJ. 2018 Jul 9;190(27):E816-E822. doi: 10.1503/cmaj.170406
Osmond, Martin H. ; Klassen, Terry P. ; Wells, George A. et al. / Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. In: CMAJ. 2018 ; Vol. 190, No. 27. pp. E816-E822.
@article{d8c444a2b2b1446bbc2b4d95a2c9332b,
title = "Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department",
abstract = "Background: There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule. Results: Of 4060 enrolled patients, 23 (0.6%) underwent neurosurgical intervention, and 197 (4.9%) had brain injury on CT. The original 7-item rule (CATCH) had sensitivities of 91.3% (95% confidence interval [CI] 72.0%-98.9%) for neurosurgical intervention and 97.5% (95% CI 94.2%-99.2%) for predicting brain injury. Adding {"}= 4 episodes of vomiting{"} resulted in a refined 8-item rule (CATCH2) with 100% (95% CI 85.2%-100%) sensitivity for neurosurgical intervention and 99.5% (95% CI 97.2%-100%) sensitivity for brain injury. Interpretation: Among children presenting to the emergency department with minor head injury, the CATCH2 rule was highly sensitive for identifying those children requiring neurosurgical intervention and those with any brain injury on CT. The CATCH2 rule should be further validated in an implementation study designed to assess its clinical impact. C 2018 Joule Inc. Or its licensors.",
author = "Osmond, {Martin H.} and Klassen, {Terry P.} and Wells, {George A.} and Jennifer Davidson and Rhonda Correll and Kathy Boutis and Gary Joubert and Serge Gouin and Simi Khangura and Troy Turner and Francois Belanger and Norm Silver and Brett Taylor and Janet Curran and Stiell, {Ian G.}",
note = "Funding Information: Funding: This study was funded by a peer-reviewed grant from the Canadian Institutes of Health Research (CIHR funding reference no. MOP-43911). Publisher Copyright: {\textcopyright} 2018 Canadian Medical Association. All rights reserved.",
year = "2018",
month = jul,
day = "9",
doi = "10.1503/cmaj.170406",
language = "English",
volume = "190",
pages = "E816--E822",
journal = "CMAJ",
issn = "0820-3946",
publisher = "Canadian Medical Association",
number = "27",
}
TY - JOUR
T1 - Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department
AU - Osmond, Martin H.
AU - Klassen, Terry P.
AU - Wells, George A.
AU - Davidson, Jennifer
AU - Correll, Rhonda
AU - Boutis, Kathy
AU - Joubert, Gary
AU - Gouin, Serge
AU - Khangura, Simi
AU - Turner, Troy
AU - Belanger, Francois
AU - Silver, Norm
AU - Taylor, Brett
AU - Curran, Janet
AU - Stiell, Ian G.
N1 - Funding Information:
Funding: This study was funded by a peer-reviewed grant from the Canadian Institutes of Health Research (CIHR funding reference no. MOP-43911).
Publisher Copyright:
© 2018 Canadian Medical Association. All rights reserved.
PY - 2018/7/9
Y1 - 2018/7/9
N2 - Background: There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule. Results: Of 4060 enrolled patients, 23 (0.6%) underwent neurosurgical intervention, and 197 (4.9%) had brain injury on CT. The original 7-item rule (CATCH) had sensitivities of 91.3% (95% confidence interval [CI] 72.0%-98.9%) for neurosurgical intervention and 97.5% (95% CI 94.2%-99.2%) for predicting brain injury. Adding "= 4 episodes of vomiting" resulted in a refined 8-item rule (CATCH2) with 100% (95% CI 85.2%-100%) sensitivity for neurosurgical intervention and 99.5% (95% CI 97.2%-100%) sensitivity for brain injury. Interpretation: Among children presenting to the emergency department with minor head injury, the CATCH2 rule was highly sensitive for identifying those children requiring neurosurgical intervention and those with any brain injury on CT. The CATCH2 rule should be further validated in an implementation study designed to assess its clinical impact. C 2018 Joule Inc. Or its licensors.
AB - Background: There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. Methods: This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Physicians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule. Results: Of 4060 enrolled patients, 23 (0.6%) underwent neurosurgical intervention, and 197 (4.9%) had brain injury on CT. The original 7-item rule (CATCH) had sensitivities of 91.3% (95% confidence interval [CI] 72.0%-98.9%) for neurosurgical intervention and 97.5% (95% CI 94.2%-99.2%) for predicting brain injury. Adding "= 4 episodes of vomiting" resulted in a refined 8-item rule (CATCH2) with 100% (95% CI 85.2%-100%) sensitivity for neurosurgical intervention and 99.5% (95% CI 97.2%-100%) sensitivity for brain injury. Interpretation: Among children presenting to the emergency department with minor head injury, the CATCH2 rule was highly sensitive for identifying those children requiring neurosurgical intervention and those with any brain injury on CT. The CATCH2 rule should be further validated in an implementation study designed to assess its clinical impact. C 2018 Joule Inc. Or its licensors.
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U2 - 10.1503/cmaj.170406
DO - 10.1503/cmaj.170406
M3 - Article
C2 - 29986857
AN - SCOPUS:85050005258
SN - 0820-3946
VL - 190
SP - E816-E822
JO - CMAJ
JF - CMAJ
IS - 27
ER -