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Type: Journal article
Title: 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)
Author: Babl, F.
Lyttle, M.
Bressan, S.
Borland, M.
Phillips, N.
Kochar, A.
Dalziel, S.
Dalton, S.
Cheek, J.
Furyk, J.
Gilhotra, Y.
Neutze, J.
Ward, B.
Donath, S.
Jachno, K.
Crowe, L.
Williams, A.
Oakley, E.
Citation: BMC Pediatrics, 2014; 14(1):148-1-148-10
Publisher: BioMed Central
Issue Date: 2014
ISSN: 1471-2431
Statement of
Franz E Babl, Mark D Lyttle, Silvia Bressan, Meredith Borland, Natalie Phillips, Amit Kochar, Stuart R Dalziel, Sarah Dalton, John A Cheek, Jeremy Furyk, Yuri Gilhotra, Jocelyn Neutze, Brenton Ward, Susan Donath, Kim Jachno, Louise Crowe, Amanda Williams, Ed Oakley on behalf of the PREDICT research network
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).
Keywords: PREDICT research network
Craniocerebral Trauma
Tomography, X-Ray Computed
Prospective Studies
Decision Support Techniques
Emergency Service, Hospital
Physician's Practice Patterns
Rights: © 2014 Babl et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
DOI: 10.1186/1471-2431-14-148
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