We’ve talked about the PECARN vs. CATCH vs. CHALICE cage-match before. PECARN has been the subject of multiple sub-investigations, but CHALICE has been neglected and gone to seed. CATCH, on the other hand, has a sequel.
What’s new in CATCH2? Vomiting!
Adding to the original 4 + 3 item list, these authors conducted a new multi-center study comprised of 4,060 children with minor head injury. The stated purpose was to prospectively evaluate CATCH, with a secondary plan to improve performance if found to be deficient – and, although it is not explicitly stated, it appears these authors anticipated the missing link to be inclusion of vomiting.
Only 23 children in their cohort required neurosurgical intervention, while 197 had any brain injury on CT. The original CATCH had sensitivity of 97.5% and specificity of 59.6% for any brain injury, while adding “≥4 episodes of vomiting” increased sensitivity to 99.5% and decreased specificity to 47.8%. Sensitivity of CATCH2 was 100% for any cases requiring neurosurgical intervention, although confidence intervals are obviously wide, given the paucity of events.
So, another entrant arrives to the pediatric head injury decision-instrument sweepstakes. Interestingly enough, these instruments were created because of concerns of CT overuse – up to 53% in 2005! – as cited by these authors. With CATCH2, the CT ordering rate would be 55%. This is both greater than the 34% rate witnessed in this study, and vastly greater than the 8% seen in Australian and New Zealand, although with different entry criteria. It would seem to me these instruments are rather making the problem worse, rather than better ….
“Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department”
http://www.cmaj.ca/content/190/27/E816