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    CATCH (Canadian Assessment of Tomography for Childhood Head injury) Rule

    Predicts clinically significant head injuries in children.
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    INSTRUCTIONS

    Use in patients up to 16 yrs with minor head injury and initial GCS at least 13, injury within 24 hrs, plus at least one of the following: blunt trauma with witnessed LOC, amnesia, witnessed disorientation, vomiting 2+ times at least 15 mins apart, persistent irritability if under 2 years old. Do NOT use if: penetrating skull injury, depressed fx, focal neuro deficit, developmental delay, child abuse, re-eval after prior head injury, pregnant patient. Note: We recommend using PECARN, as it is more widely validated.

    When to Use
    Pearls/Pitfalls
    Why Use

    Pediatric patients up to 16 years old with minor head injury and:

    • Initial GCS ≥13 on physician determination,
    • Injury within 24 hours, AND
    • At least one of the following:
      • Blunt trauma to the head with witnessed loss of consciousness.
      • Definite amnesia.
      • Witnessed disorientation.
      • Vomiting two or more times at least 15 minutes apart.
      • Persistent irritability in a child under two years.

    Do not use in any of the following situations:

    • Penetrating skull injury.
    • Depressed fractures.
    • Acute focal neurological deficit.
    • Chronic generalized developmental delay.
    • Suspected child abuse.
    • Returning for re-evaluation after prior head injury.
    • Pregnant patients.
    • Identifies high risk patients with specific signs and symptoms.
    • Generalizability is limited, as it uses numerous strict inclusion and exclusion criteria.
    • Less sensitive than the PECARN Algorithm.
    • Original study included detailed sensitivity analysis for combinations of risk factors, perhaps giving a more nuanced approach to the decision to obtain CT.
    • Intoxicated patients were not excluded, making GCS estimation potentially unreliable.

    Original study included detailed sensitivity analysis for combinations of risk factors, perhaps giving a more nuanced approach to the decision to obtain CT.

    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
    Yes
    No
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    No
    Yes

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Patients who do not meet criteria for imaging should always be counseled about concussion and its symptoms and strict head injury return precautions (e.g. vomiting, somnolence, altered mental status).
    • Many still recommend a period of observation after head injury.

    Management

    Patients require CT if they have any of the high risk or medium risk factors. High risk predicts need for neurologic intervention; medium risk predicts brain injury on CT scan.

    Content Contributors
    • Diana Fleisher, MD
    About the Creator
    Dr. Martin H. Osmond
    Are you Dr. Martin H. Osmond?
    Content Contributors
    • Diana Fleisher, MD