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

CT of the head is required only for children with minor head injury* and any one of the following findings:

High risk (need for neurologic intervention)

1. Glasgow Coma Scale score <15 at two hours after injury

2. Suspected open or depressed skull fracture

3. History of worsening headache

4. Irritability on examination

Medium risk (brain injury on CT scan)

5. Any sign of basal skull fracture (eg, hemotympanum, "raccoon" eyes, otorrhea or rhinorrhea of the cerebrospinal fluid, Battle's sign)

6. Large, boggy hematoma of the scalp

7. Dangerous mechanism of injury (eg, motor vehicle crash, fall from elevation ≥3 ft [≥91 cm] or 5 stairs, fall from bicycle with no helmet)

CT: computed tomography.
* Minor head injury is defined as injury within the past 24 hours associated with witnessed loss of consciousness, definite amnesia, witnessed disorientation, persistent vomiting (more than one episode) or persistent irritability (in a child under two years of age) in a patient with a Glasgow Coma Scale score of 13-15.

Reproduced with permission from: Osmond MH, Klassen TP, Welss GA, et al. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ 2010; 182:341. Copyright © 2010 Canadian Medical Association. All rights reserved. This work is protected by copyright and the making of this copy was with the permission of Access Copyright. Any alteration of its content or further copying in any form whatsoever is strictly prohibited unless otherwise permitted by law.

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