When to, and when NOT to, order CT imaging in children with traumatic head injury is an important part of practice.
The OLD Canadian Assessment of Tomography for Childhood Head injury (CATCH) tool has been updated with a NEW question that increases its sensitivity for neurosurgical intervention and for brain injury - have there been "≥ 4 episodes of vomiting"?
So CATCH2 is now 8 questions and not the old 7.
Let's CATCH up on the old list...
Can you name 7 findings that alone would trigger head CT in children with a minor head injury?
1. GCS less then 15 at 2 hours post injury
2. Suspected open or depressed skull fracture
3. Worsening headache
5. Signs of basal skull fracture
6. Large, boggy hematoma
7. Dangerous mechanism (fall from a bike with no helmet, MVA, fall from height greater than or equal to 3 feet)
Now in addition to that list remember ≥ 4 episodes of vomiting (an "episode" being separated from another "episode" by 15 minutes in time, i.e. child vomits a bit....15 minutes later spends 2 minutes vomiting = 2 episodes).
Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department
Martin H. Osmond, Terry P. Klassen, George A. Wells, Jennifer Davidson, Rhonda Correll, Kathy Boutis, Gary Joubert, Serge Gouin, Simi Khangura, Troy Turner, Francois Belanger, Norm Silver, Brett Taylor, Janet Curran and Ian G. Stiell; for the Pediatric Emergency Research Canada (PERC) Head Injury Study Group
CMAJ July 09, 2018 190 (27) E816-E822; DOI: https://doi.org/10.1503/cmaj.170406
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