Methodology Score: 3.5/5
Usefulness Score: 4/5

Babl FE, et al. Lancet. 2017 Jun 17;389(10087):2393-2402.

Question and Methods: This prospective observational study sought to externally validate and subsequently compare the relative performance of the PECARN, CATCH, and CHALICE paediatric head injury CDRs.

Findings: The validation cohort demonstrated a sensitivity of 100% for PECARN <2 years, 99% for PECARN >=2 years, 95.2% for CATCH with high-risk predictors, 88.7% for CATCH with medium and high-risk predictors, and 92.3% for CHALICE, with similar results obtained in the comparison cohort.

Limitations: Lack of appropriate blinding and 10% loss to follow-up may have led to biased results.

Interpretation/Limitations: This paper has provided level 2 evidence supporting the use of these 3 clinical decision rules and highlights the highest sensitivity of PECARN.

By: Dr. Nick Prudhomme

Epi Lesson – Major Steps in the Development of a Clinical Decision Rule

The first step entails a derivation study that ideally is conducted prospectively and has a large number of outcome cases. The second step is a prospective validation study that explicitly evaluates the new rule for accuracy, physician acceptability and potential impact. The third step is an implementation trial to evaluate the actual impact of the rule on patient outcomes in real clinical practice.

By: Dr. Ian Stiell 

Hans Rosenberg
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.