Evaluation of Computed Tomography Decision-Making in Pediatric Minor Head Trauma: PECARN, CATCH, AND CHALICE

Aim: This study aimed to evaluate the appropriateness of computed tomography (CT) indications according to the Pediatric Emergency Care Applied Research Network (PECARN), the Canadian Assessment of Tomography for Childhood Head Injury (CATCH), and the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) clinical decision rules in pediatric patients presenting to the emergency department with minor head trauma for whom neurosurgical consultation was requested, and to compare the diagnostic performance of these rules. Method: In this retrospective study, a total of 104 pediatric patients aged 0–18 years, with a Glasgow Coma Scale (GCS) score of 13–15, who presented to the emergency department between October 1, 2024 and September 30, 2025 and for whom neurosurgical consultation was requested, were evaluated. Cranial computed tomography was performed in all patients. Taking CT findings as the reference standard, the sensitivity, specificity, positive predictive value, and negative predictive value of the PECARN, CATCH, and CHALICE clinical decision rules were calculated. Results: Abnormal CT findings were detected in 27 of 104 patients (26.0%). The sensitivities of the PECARN, CATCH, and CHALICE rules were 70.4%, 66.7%, and 63.0%, respectively, whereas their specificities were 50.6%, 59.7%, and 72.7%, respectively. PECARN showed the highest sensitivity, while CHALICE demonstrated the highest specificity. No abnormal CT findings were identified in 74.0% of the patients. Conclusion: The PECARN, CATCH, and CHALICE clinical decision rules are useful tools for guiding CT use in pediatric minor head trauma. PECARN prioritizes patient safety with its higher sensitivity, whereas CHALICE offers a more selective approach for reducing unnecessary imaging with its higher specificity. Appropriate use of these clinical decision rules may help reduce unnecessary radiation exposure; however, they should be applied in conjunction with clinical evaluation during the decision-making process.