The Children’s Head injury ALgorithm for prediction of Clinically Important Events (CHALICE) clinical decision rule was developed to predict clinically important brain injuries in children with head trauma. This rule identifies high-risk criteria and divides them into history, examination and mechanism 1.
- witnessed loss of consciousness >5 min
- amnesia >5 min (anterograde or retrograde)
- abnormal drowsiness noted by attending doctor
- >2 vomits post injury
- suspicion of non-accidental injury
- seizure after a head injury in a child with no history of epilepsy
- GCS <14, or <15 if less than 1 year old
- suspicion of penetrating or depressed skull injury or tense fontanelle
- signs of base of skull fracture
- blood/CSF rhinorrhoea or otorrhoea
- panda eyes
- Battle’s sign
- facial crepitus or serious facial injury
- presence of focal neurological signs
- presence of bruise, swelling or laceration >5cm if <1 year old
- road traffic accident with speed >40 mph in which the patient is an occupant, pedestrian or cyclist
- fall of >3m in height
- high speed injury from projectile or object
If none of the above criteria are present then the patient is deemed low risk for a clinically significant intracranial finding.
The literature reports an 84-98% sensitivity of the CHALICE clinical decision rule for detecting clinically important intracranial injury in paediatric patients 1-4.
In studies that have sought to compare clinical decision rules for paediatric head injury assessment - namely the CHALICE, CATCH (Canadian Assessment of Tomography for Childhood Head) and PECARN (Pediatric Emergency Care Applied Research Network) rules - the PECARN rule has been found to have the highest sensitivity (99-100%) in detection of clinically important brain injuries 2,3. However, the CHALICE rule is applicable in a considerably higher percentage of cases (97-99% all cases vs 75-76% in under 2-year-olds and 74-76% over 2-years-old for PECARN) 3,4.
- 1. Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Archives of disease in childhood. 91 (11): 885-91.
- 2. 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. Annals of emergency medicine. 64 (2): 145-52, 152.e1-5.
- 3. Babl FE, Borland ML, Phillips N, Kochar A, Dalton S, McCaskill M, Cheek JA, Gilhotra Y, Furyk J, Neutze J, Lyttle MD, Bressan S, Donath S, Molesworth C, Jachno K, Ward B, Williams A, Baylis A, Crowe L, Oakley E, Dalziel SR. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet (London, England). 389 (10087): 2393-2402.
- 4. Lyttle MD, Cheek JA, Blackburn C, Oakley E, Ward B, Fry A, Jachno K, Babl FE. Applicability of the CATCH, CHALICE and PECARN paediatric head injury clinical decision rules: pilot data from a single Australian centre. Emergency medicine journal : EMJ. 30 (10): 790-4.
Clinical decision rules
clinical decision rules (overview)
- NEXUS Chest (blunt chest trauma)