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A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): The Australasian Paediatric Head Injury Rules Study (APHIRST)

Oakley, Ed; Lyttle, Mark D.; Williams, Amanda; Crowe, Louise; Jachno, Kim; Donath, Susan; Neutze, Jocelyn; Gilhotra, Yuri; Cheek, John A.; Dalziel, Stuart R.; Ward, Brenton; Lyttle, Mark; Babl, Franz E.; Dalziel, Stuart R; Cheek, John; Bressan, Silvia; Borland, Meredith; Phillips, Natalie; Kochar, Amit; Dalton, Sarah; Furyk, Jeremy

Authors

Ed Oakley

Mark D. Lyttle

Amanda Williams

Louise Crowe

Kim Jachno

Susan Donath

Jocelyn Neutze

Yuri Gilhotra

John A. Cheek

Stuart R. Dalziel

Brenton Ward

Mark Lyttle mark.lyttle@uwe.ac.uk

Franz E. Babl

Stuart R Dalziel

John Cheek

Silvia Bressan

Meredith Borland

Natalie Phillips

Amit Kochar

Sarah Dalton

Jeremy Furyk



Abstract

Background: Head injuries in children are responsible for a large number of emergency department visits. Failure to identify a clinically significant intracranial injury in a timely fashion may result in long term neurodisability and death. Whilst cranial computed tomography (CT) provides rapid and definitive identification of intracranial injuries, it is resource intensive and associated with radiation induced cancer. Evidence based head injury clinical decision rules have been derived to aid physicians in identifying patients at risk of having a clinically significant intracranial injury. Three rules have been identified as being of high quality and accuracy: the Canadian Assessment of Tomography for Childhood Head Injury (CATCH) from Canada, the Children's Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) from the UK, and the prediction rule for the identification of children at very low risk of clinically important traumatic brain injury developed by the Pediatric Emergency Care Applied Research Network (PECARN) from the USA. This study aims to prospectively validate and compare the performance accuracy of these three clinical decision rules when applied outside the derivation setting.Methods/design: This study is a prospective observational study of children aged 0 to less than 18 years presenting to 10 emergency departments within the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network in Australia and New Zealand after head injuries of any severity. Predictor variables identified in CATCH, CHALICE and PECARN clinical decision rules will be collected. Patients will be managed as per the treating clinicians at the participating hospitals. All patients not undergoing cranial CT will receive a follow up call 14 to 90 days after the injury. Outcome data collected will include results of cranial CTs (if performed) and details of admission, intubation, neurosurgery and death. The performance accuracy of each of the rules will be assessed using rule specific outcomes and inclusion and exclusion criteria.Discussion: This study will allow the simultaneous comparative application and validation of three major paediatric head injury clinical decision rules outside their derivation setting.Trial registration: The study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR)- ACTRN12614000463673 (registered 2 May 2014). © 2014 Babl et al.; licensee BioMed Central Ltd.

Journal Article Type Article
Publication Date Jun 13, 2014
Journal BMC Pediatrics
Electronic ISSN 1471-2431
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 14
Issue 1
Pages 148
APA6 Citation Oakley, E., Williams, A., Crowe, L., Jachno, K., Donath, S., Neutze, J., …Furyk, J. (2014). A prospective observational study to assess the diagnostic accuracy of clinical decision rules for children presenting to emergency departments after head injuries (protocol): The Australasian Paediatric Head Injury Rules Study (APHIRST). BMC Pediatrics, 14(1), 148. https://doi.org/10.1186/1471-2431-14-148
DOI https://doi.org/10.1186/1471-2431-14-148
Keywords head injury, clinical decision rule, computed tomography, validation
Publisher URL http://dx.doi.org/10.1186/1471-2431-14-148

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