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    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
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    CHALICE (Children's Head injury ALgorithm for the prediction of Important Clinical Events) Rule

    Predicts death, need for neurosurgical intervention or CT abnormality in children with head trauma.


    Use in children under age 16 years with history or signs of head injury. Note: We recommend using PECARN over other pediatric head trauma rules, as it is the most widely validated.

    When to Use

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    A CT head is required if any of the following criteria are present:


    • Witnessed loss of consciousness of >5 min duration.
    • History of amnesia (either antegrade or retrograde) of >5 min duration.
    • Abnormal drowsiness (defined as drowsiness in excess of that expected by the examining doctor).
    • ≥3 vomits after head injury (a vomit is defined as a single discrete episode of vomiting).
    • Suspicion of non‐accidental injury (NAI, defined as any suspicion of NAI by the examining doctor).
    • Seizure after head injury in a patient who has no history of epilepsy.


    • Glasgow Coma Score (GCS) <14, or GCS <15 if <1 year old.
    • Suspicion of penetrating or depressed skull injury, or tense fontanelle.
    • Signs of a basal skull fracture (defined as evidence of blood or cerebrospinal fluid from ear or nose, panda eyes, Battle's sign, hemotympanum, facial crepitus, or serious facial injury).
    • Positive focal neurologic sign (defined as any focal neurologic sign, including motor, sensory, coordination, or reflex abnormality).
    • Presence of bruise, swelling or laceration >5 cm if <1 year old.


    • High‐speed road traffic accident either as pedestrian, cyclist or occupant (defined as accident with speed >40 mph).
    • Fall of >3 m in height.
    • High‐speed injury from a projectile or an object.

    If none of the above variables are present, the patient is at low risk of intracranial pathology.

    Dr. Joel Dunning

    About the Creator

    Joel Dunning, FRCS, PhD, is a practicing cardiothoracic surgeon at James Cook University Hospital in Middlesbrough, United Kingdom. He developed the CHALICE Rule as part of his PhD as a junior doctor. Dr. Dunning is an associate editor of the European Journal of Cardio-Thoracic Surgery and co-editor in chief of

    To view Dr. Joel Dunning's publications, visit PubMed

    About the Creator
    Dr. Joel Dunning