Canadian physicians have developed a clinical decision rule for using computed tomography (CT) for children with minor head injuries. The decision rule is discussed in an article in the latest Canadian Medical Association Journal, "CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury."

The authors state that a small portion of child patients can experience deterioration after head injury, and possibly need neurosurgical intervention for intracranial hematoma. CT use in the ER can help in the diagnosis.

The problem with CT is its significant cost and exposure of children to ionizing radiation. The concern over radiation exposure through diagnostic scanning continues to be a major issue in the medical community, and particularly pediatrics. The authors point out the concern includes early exposure to ionizing radiation possibly resulting in a rise of lifetime risk of fatal cancer.
But by making a more successful clinical decision practitioners can possibly reduce the number of children undergoing CT, limiting costs and exposure to radiation as well as standardizing and improving the use of CT for children with minor head injuries.

CATCH Rule

The resulting rule from the research is called the CATCH rule (Canadian Assessment of Tomography for Childhood Head injury).

"We have developed a clinical decision rule that can be used to identify two levels of risk in children with minor head injury," wrote Martin H. Osmond, M.D., CM, lead researcher. "Patients with any one of four high risk factors are at significant risk of needing neurological intervention, whereas patients with any of three additional medium risk characteristics are at risk of having a brain injury that will be seen on CT."

The CATCH rule spells out what symptoms and guidelines are to be used to assess whether CT is indicated in minor head injuries. CATCH identifies both high- and medium-risk parameters (see link below).

The research for the CATCH rule resulted in 100 percent sensitivity for high-risk factors and for predicting the need for neurologic intervention and whether a patient should undergo CT. The medium-risk factors had 98.1 percent sensitivity.

Read the study for important definitions and CATCH parameters:

The article may be accessed at: http://www.cmaj.ca/cgi/rapidpdf/cmaj.091421v1?maxtoshow=&hits=10&RESULTFORMAT=1&author1=Osmond%2C+martin&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT,HWELTR

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