Physician practice and PECARN rule outperform CATCH and CHALICE rules based on the detection of traumatic brain injury as defined by PECARN.

Context The recognition of significant traumatic intracranial injuries is important and cranial CT is the gold standard for their diagnosis. However, CT bears risks associated with ionising radiation-induced malignancies, in particular in children. Three high-quality clinical decision rules (CDR) have been developed to assist with decision-making on whether or not to use a cranial CT scan in children who sustain a trauma to the head: the Canadian Assessment of Tomography for Childhood Head injury (CATCH) the Children’s Head injury Algorithm for the prediction of Important Clinical Events (CHALICE) and the rule developed by the Pediatric Emergency Care Applied Research Network (PECARN). They differ significantly in their predictor variables and suggested course of action. They have been derived using different outcomes, inclusion and exclusion criteria and have focused on different severities of head injuries. Only PECARN has been validated outside the derivation population. It is unclear which rule is the best for clinicians to use.