Skip to main content

Comparison of PECARN and CATCH clinical decision rules in children with minor blunt head trauma


Introduction and purpose

Computerized brain tomography (CBT) imaging plays a key role in the management of patients with head trauma, and there is an indication for CBT in moderate and severe injuries. However, it is difficult to determine an indication for CBT in patients with minor head trauma. The primary aim of this study is to compare the efficiency of the most commonly used clinical decision rules: the guidelines of the Pediatric Emergency Care Applied Research Network (PECARN), and those of the Canadian Assessment of Tomography for Childhood Head Injury (CATCH).


The study, which was designed as a prospective cohort study, sought to determine the appropriate CBT indications for children younger than 18 years who were referred to the emergency department with minor blunt head trauma. The effectiveness of PECARN and CATCH clinical decision rules, which are recommended by literature to be applied in order to diagnose severely injured patients and minimize inappropriate CBT requests, was investigated. All patients included in this study were younger than 18 years of age, were admitted to the study with an isolated blunt head trauma, had a GCS of > 13, and had parental permission to participate in the study. Patients ages 18 and older, those with penetrating head trauma or trauma to other systems, those with GCS ≤ 13, those with incomplete data, and those whose parents did not agree to participate in the study, were excluded.


A total of 256 patients were included in the study. PECARN and CATCH rules were both shown to be statistically significant in detecting the presence of pathology (p < 0.001, p = 0.002, respectively). Overall, PECARN was more successful than CATCH in detecting intracranial pathology. The sensitivity of PECARN was 95 (95% CI 72–100%) and specificity was 53 (95% CI 47–60%), while the sensitivity of CATCH was 48 (95% CI 25–71%) and specificity was 83 (95% CI 79–88%). Multivariate regression analyses were performed on the parameters (low GCS, abnormal mental status, age, non-frontal hematoma) and other parameters (vomiting, headache, abnormal behavior according to parents) that were considered to be clinically significant despite having a p value of < 0.3. Age, low GCS, and non-frontal hematoma presence were found to be significant in predicting the presence of pathology. In particular, low GCS increased the probability of pathology 5.94-fold and non-frontal hematoma presence 4.37-fold.


While both PECARN and CATCH were found to be effective in determining the necessity of CBT for children with minor blunt head trauma, PECARN proved to be more useful for emergency services because of its higher sensitivity. The authors suggest that conducting a CBT scan based on clinical decision rules may be a suitable approach for early detection of the presence of intracranial acute pathologies in young children with minor blunt head trauma, especially if the GCS score is < 15 and non-frontal hematomas are present.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Shackford SR, Wald SL, Ross SE, Cogbill TH, Hoyt DB, Morris JA, Mucha PA, Pachter HL, Sugerman HJ, O’Malley K. The clinical utility of computed tomographic scanning and neurologic examination in the management of patients with minor head injuries. J Trauma. 1992;33(3):385–94.

    CAS  Article  Google Scholar 

  2. Stein SC, Ross SE. The value of computed tomographic scans in patients with low-risk head injuries. Neurosurgery. 1990;26(4):638–40.

    CAS  Article  Google Scholar 

  3. Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, Nadel FM, Monroe D, Stanley RM, Borgialli DA, Badawy MK, Schunk JE, Quayle KS, Mahajan P, Lichenstein R, Lillis KA, Tunik MG, Jacobs ES, Callahan JM, Gorelick MH, Glass TF, Lee LK, Bachman MC, Cooper A, Powell EC, Gerardi MJ, Melville KA, Muizelaar JP, Wisner DH, Zuspan SJ, Dean JM, Wootton-Gorges SL, Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009;374(9696):1160–70. doi:10.1016/S0140-6736(09)61558-0 (Epub 2009 Sep 14. Erratum in: Lancet. 2014 Jan 25;383(9914):308).

    Article  PubMed  Google Scholar 

  4. Bouida W, Marghli S, Souissi S, Ksibi H, Methammem M, Haguiga H, Khedher S, Boubaker H, Beltaief K, Grissa MH, Trimech MN, Kerkeni W, Chebili N, Halila I, Rejeb I, Boukef R, Rekik N, Bouhaja B, Letaief M, Nouira S. Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study. Ann Emerg Med. 2013 May;61(5):521–7. doi:10.1016/j.annemergmed.2012.07.016 (Epub 2012 Aug 22).

    Article  PubMed  Google Scholar 

  5. Kavalci C, Aksel G, Salt O, Yilmaz MS, Demir A, Kavalci G, Akbuga Ozel B, Altinbilek E, Durdu T, Yel C, Durukan P, Isik B. Comparison of the Canadian CT head rule and the new orleans criteria in patients with minor head injury. World J Emerg Surg. 2014;9:31. doi:10.1186/1749-7922-9-31 (2014 Apr 17 eCollection).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stiell IG, Wells GA, Vandemheen K, Clement C, Lesiuk H, Laupacis A, McKnight RD, Verbeek R, Brison R, Cass D, Eisenhauer ME, Greenberg G, Worthington J. The Canadian CT head rule for patients with minor head injury. Lancet. 2001;357(9266):1391–6.

    CAS  Article  Google Scholar 

  7. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4.

    CAS  Article  Google Scholar 

  8. Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K. Children’s head injury algorithm for the prediction of important clinical events study group. Derivation of the children’s head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;91(11):885–91.

    CAS  Article  Google Scholar 

  9. Palchak MJ, Holmes JF, Vance CW, Gelber RE, Schauer BA, Harrison MJ, Willis-Shore J, Wootton-Gorges SL, Derlet RW, Kuppermann N. Does an isolated history of loss of consciousness or amnesia predict brain injuries in children after blunt head trauma? Pediatrics. 2004;113(6):e507–13.

    Article  Google Scholar 

  10. Quayle KS, Jaffe DM, Kuppermann N, Kaufman BA, Lee BC, Park TS, McAlister WH. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics. 1997;99(5):E11.

    CAS  Article  Google Scholar 

  11. Atabaki SM, Stiell IG, Bazarian JJ, Sadow KE, Vu TT, Camarca MA, Berns S, Chamberlain JM. A clinical decision rule for cranial computed tomography in minor pediatric head trauma. Arch Pediatr Adolesc Med. 2008;162(5):439–45. doi:10.1001/archpedi.162.5.439.

    Article  PubMed  Google Scholar 

  12. Dayan PS, Holmes JF, Atabaki S, Hoyle J Jr, Tunik MG, Lichenstein R, Alpern E, Miskin M, Kuppermann N. Traumatic Brain Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Association of traumatic brain injuries with vomiting in children with blunt head trauma. Ann Emerg Med. 2014;63(6):657–65. doi:10.1016/j.annemergmed.2014.01.009 (Epub 2014 Feb 19).

    Article  PubMed  Google Scholar 

  13. Bressan S, Romanato S, Mion T, Zanconato S, Da Dalt L. Implementation of adapted PECARN decision rule for children with minor head injury in the pediatric emergency department. Acad Emerg Med. 2012;19(7):801–7.

    Article  Google Scholar 

  14. Güzel A, Hiçdönmez T, Temizöz O, Aksu B, Aylanç H, Karasalihoglu S. Indications for brain computed tomography and hospital admission pediatric patients with minor head injury: how much can we rely upon clinical findings? Pediatr Neurosurg. 2009;45(4):262–70. doi:10.1159/000228984 (Epub 2009 Jul 17).

    Article  PubMed  Google Scholar 

  15. Çete Y, Pekdemir M, Oktay C, Eray O, Bozan H, Ersoy FF. The role of computed tomography for minor head injury. Ulus Travma Derg. 2001;7(3):189–94.

    PubMed  Google Scholar 

  16. Glass T, Ruddy RM, Alpern ER, Gorelick M, Callahan J, Lee L, Gerardi M, Melville K, Miskin M, Holmes JF, Kuppermann N. Pediatric Emergency Care Applied Research Network (PECARN). Traumatic brain injuries and computed tomography use in pediatric sports participants. Am J Emerg Med. 2015;33(10):1458–64. doi:10.1016/j.ajem.2015.06.069 (Epub 2015 Jul 6).

    Article  PubMed  Google Scholar 

  17. Miller EC, Derlet RW, Kinser D. Minor head trauma; is computed tomography always necessary? Ann of Emerg Med. 1996;27:290.

    CAS  Article  Google Scholar 

  18. Easter JS, Bakes K, Dhaliwal J, Miller M, Caruso E, Haukoos JS. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med. 2014;64(2):145–52 (152.e1–5).

    Article  Google Scholar 

  19. Shane SA, Fuchs SM. Skull fractures in infants and predictors of associated intracranial injury. Pediatr Emerg Care. 1997;13:198–203.

    CAS  Article  Google Scholar 

  20. Greenes DS, Schutzman SA. Clinical significance of scalp abnormalities in asymptomatic head-injured infants. Pediatr Emerg Care. 2001;17:88–92.

    CAS  Article  Google Scholar 

  21. Bin SS, Schutzman SA, Greenes DS. Validation of a clinical score to predict skull fracture in head-injured infants. Pediatr Emerg Care. 2010;26:633–9.

    Article  Google Scholar 

  22. Dayan PS, Holmes JF, Schutzman S, Schunk J, Lichenstein R, Foerster LA, Hoyle J Jr, Atabaki S, Miskin M, Wisner D, Zuspan S, Kuppermann N. Traumatic Brain Injury Study Group of the Pediatric Emergency Care Applied Research Network (PECARN). Risk of traumatic brain injuries in children younger than 24 months with isolated scalp hematomas. Ann Emerg Med. 2014;64(2):153–62. doi:10.1016/j.annemergmed.2014.02.003 (Epub 2014 Mar 11).

    Article  PubMed  Google Scholar 

  23. Schonfeld D, Bressan S, Da Dalt L, Henien MN, Winnett JA, Nigrovic LE. Pediatric Emergency Care Applied Research Network head injury clinical prediction rules are reliable in practice. Arch Dis Child 2014;99(5):427–31. doi:10.1136/archdischild-2013-305004 (Epub 2014 Jan 15).

    Article  PubMed  Google Scholar 

  24. Thiam DW, Yap SH, Chong SL. Clinical decision rules for paediatric minor head injury: are CT scans a necessary evil? Ann Acad Med Singapore. 2015;44(9):335–41.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to G. Aksel.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bozan, Ö., Aksel, G., Kahraman, H.A. et al. Comparison of PECARN and CATCH clinical decision rules in children with minor blunt head trauma. Eur J Trauma Emerg Surg 45, 849–855 (2019).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Blunt head ınjury
  • Clinical decision making
  • Computerized tomography