Comparison of predictive tools for management of paediatric mild TBI: a prospective cohort study
Abstract
Summary 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 (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 10.13039/501100009963Forskning och Utveckling Halland.
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 3,012 participants or records.
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