Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Comparison of predictive tools for management of paediatric mild TBI : a prospective cohort study

Wickbom, Fredrik LU orcid ; Thornberg, Sarah ; Sotoca Fernandez, Jorge LU ; Silfver, Rasmus ; Marklund, Niklas LU orcid and Undén, Johan LU (2025) In EClinicalMedicine 88.
Abstract

Background: Multiple clinical practice guidelines and head computed tomography decision rules exist for emergency department (ED) triage of children with traumatic brain injury (TBI). These vary in structure, aim, target cohort, and outcomes, yet are used clinically in similar populations. We compared important clinical and practical characteristics of all major guidelines in a large, real-world paediatric traumatic brain injury (TBI) cohort. Methods: Prospective, pragmatic, observational study of children (<18 years of age) presenting with mild-moderate TBI to 16 EDs in Sweden and Norway, including prospective documentation of guideline-specific risk factors and outcomes between April 2018 and May 2024. We assessed the diagnostic... (More)

Background: Multiple clinical practice guidelines and head computed tomography decision rules exist for emergency department (ED) triage of children with traumatic brain injury (TBI). These vary in structure, aim, target cohort, and outcomes, yet are used clinically in similar populations. We compared important clinical and practical characteristics of all major guidelines in a large, real-world paediatric traumatic brain injury (TBI) cohort. Methods: Prospective, pragmatic, observational study of children (<18 years of age) presenting with mild-moderate TBI to 16 EDs in Sweden and Norway, including prospective documentation of guideline-specific risk factors and outcomes between April 2018 and May 2024. We assessed the diagnostic accuracy and characteristics of CATCH, CATCH2, CHALICE, PECARN, SNC16, PREDICT, and NICE23, both within guideline-specific application cohorts and across the full study cohort. The primary comparative outcome was significant trauma-related findings on cranial computed tomography (cCT). Secondary outcomes were neurosurgical interventions and guideline-specific endpoints. The study was registered at ClinicalTrials.gov (NCT05964764). Findings: The full cohort consisted of 3012 children (median age, 5.6 years; SD, 4.8). Among these, 0.9% (27/3012) had significant cCT findings, and 2/3012 (0.07%) required neurosurgery. CATCH and CATCH2 could be applied to 31.0% (934/3012) of patients, whereas the remaining guidelines were applicable to >94% of the cohort. In a comparative analysis concerning significant cCT findings, the lowest sensitivity estimates were 74.1% (95% CI: 53.7–88.9) for both PECARN ≥2 years and PREDICT ≥2 years; the highest was 100% (95% CI: 87.2–100.0) for SNC16. Specificity ranged from 41.6% (95% CI: 39.8–43.4) for SNC16 to 78.3% (95% CI: 76.8–79.8) for CHALICE. Mandatory cCT rates varied from 1.2% (PREDICT ≥2 years) to 29.9% (CATCH2). Interpretation: A head-to-head comparison in a real-world, paediatric, TBI cohort highlights key features of established guidelines and decision rules, offering insight into their comparative diagnostic accuracy, practical application and clinical impact. Funding: This work was supported by non-commercial state funding from Södra Sjukvårdsregionen, Vetenskapliga Rådet (Hallands Hospital), and Forskning och Utveckling Halland.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; ; and
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Children, Comparison, Diagnostic accuracy, Guidelines, Traumatic brain injury
in
EClinicalMedicine
volume
88
article number
103484
publisher
Lancet Publishing Group
external identifiers
  • scopus:105015096586
  • pmid:40979218
ISSN
2589-5370
DOI
10.1016/j.eclinm.2025.103484
language
English
LU publication?
yes
id
d54c583c-d2ea-4087-a1e4-2c455831a341
date added to LUP
2025-10-10 13:29:49
date last changed
2025-10-14 12:52:31
@article{d54c583c-d2ea-4087-a1e4-2c455831a341,
  abstract     = {{<p>Background: Multiple clinical practice guidelines and head computed tomography decision rules exist for emergency department (ED) triage of children with traumatic brain injury (TBI). These vary in structure, aim, target cohort, and outcomes, yet are used clinically in similar populations. We compared important clinical and practical characteristics of all major guidelines in a large, real-world paediatric traumatic brain injury (TBI) cohort. Methods: Prospective, pragmatic, observational study of children (&lt;18 years of age) presenting with mild-moderate TBI to 16 EDs in Sweden and Norway, including prospective documentation of guideline-specific risk factors and outcomes between April 2018 and May 2024. We assessed the diagnostic accuracy and characteristics of CATCH, CATCH2, CHALICE, PECARN, SNC16, PREDICT, and NICE23, both within guideline-specific application cohorts and across the full study cohort. The primary comparative outcome was significant trauma-related findings on cranial computed tomography (cCT). Secondary outcomes were neurosurgical interventions and guideline-specific endpoints. The study was registered at ClinicalTrials.gov (NCT05964764). Findings: The full cohort consisted of 3012 children (median age, 5.6 years; SD, 4.8). Among these, 0.9% (27/3012) had significant cCT findings, and 2/3012 (0.07%) required neurosurgery. CATCH and CATCH2 could be applied to 31.0% (934/3012) of patients, whereas the remaining guidelines were applicable to &gt;94% of the cohort. In a comparative analysis concerning significant cCT findings, the lowest sensitivity estimates were 74.1% (95% CI: 53.7–88.9) for both PECARN ≥2 years and PREDICT ≥2 years; the highest was 100% (95% CI: 87.2–100.0) for SNC16. Specificity ranged from 41.6% (95% CI: 39.8–43.4) for SNC16 to 78.3% (95% CI: 76.8–79.8) for CHALICE. Mandatory cCT rates varied from 1.2% (PREDICT ≥2 years) to 29.9% (CATCH2). Interpretation: A head-to-head comparison in a real-world, paediatric, TBI cohort highlights key features of established guidelines and decision rules, offering insight into their comparative diagnostic accuracy, practical application and clinical impact. Funding: This work was supported by non-commercial state funding from Södra Sjukvårdsregionen, Vetenskapliga Rådet (Hallands Hospital), and Forskning och Utveckling Halland.</p>}},
  author       = {{Wickbom, Fredrik and Thornberg, Sarah and Sotoca Fernandez, Jorge and Silfver, Rasmus and Marklund, Niklas and Undén, Johan}},
  issn         = {{2589-5370}},
  keywords     = {{Children; Comparison; Diagnostic accuracy; Guidelines; Traumatic brain injury}},
  language     = {{eng}},
  publisher    = {{Lancet Publishing Group}},
  series       = {{EClinicalMedicine}},
  title        = {{Comparison of predictive tools for management of paediatric mild TBI : a prospective cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.eclinm.2025.103484}},
  doi          = {{10.1016/j.eclinm.2025.103484}},
  volume       = {{88}},
  year         = {{2025}},
}