The Children's head injury algorithm for the prediction of important clinical events (CHALICE) can be used to evaluate a child after head injury. This can help identify children who are at risk for intracranial pathology and who should undergo head CT scan. The authors are from the Manchester Royal Infirmary, University of Manchester and the CHALICE study group.

Patient selection: age < 16 years of age with head injury


Indications for head CT in child - one or more of the following:

(1) witnessed loss of consciousness lasting > 5 minutes

(2) history of antegrade or retrograde amnesia lasting > 5 minutes

(3) abnormal drowsiness observed by the examining physician

(4) >= 3 discrete episodes of vomiting

(5) suspicion by the examining physician of non-accidental injury

(6) seizure after head injury AND no previous history of epilepsy

(7) Glasgow coma score < 14 if >= 1 year old OR GCS < 15 if < 1 year old

(8) suspicion of penetrating skull injury

(9) suspicion of depressed skull injury

(10) tense fontanelle in an infant

(11) clinical signs of a basal skull fracture

(12) focal neurological sign (motor, sensory, reflex, and/or coordination abnormality)

(13) bruise, laceration or swelling > 5 cm in dimension AND < 1 year old

(14) pedestrian or cyclist in a traffic accident

(15) vehicle occupant in a traffic accident AND speed > 40 miles per hour

(16) fall from height > 3 meters

(17) high speed injury to head from a projectile or object



• Signs of a basal skull fracture includes: blood or CSF draining from nose or ear, "Panda" eyes, Battles sign, hemotympanum, facial crepitus, or serious facial injury.

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