MDCalc

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.

History

Witnessed LOC >5 min
Amnesia >5 min
Antegrade or retrograde
Abnormal drowsiness
Abnormal = in excess of drowsiness expected by the examining doctor
≥3 vomits after head injury
1 vomit = single discrete episode of vomiting
Suspicion of non‐accidental injury (NAI)
Any suspicion of NAI by the examining doctor
Seizure after head injury (and no previous history of epilepsy)

Examination

GCS <14 (or GCS <15 if <1 year old)
Suspicion of penetrating or depressed skull injury, or tense fontanelle
Signs of basal skull fracture
Blood or CSF from ear or nose, panda eyes, Battle's sign, hemotympanum, facial crepitus, or serious facial injury
Positive focal neurologic sign
Any focal neurologic sign (motor, sensory, coordination, or reflex abnormality)
Bruise, swelling or laceration >5 cm (if <1 year old)

Mechanism

High‐speed road traffic accident as pedestrian, cyclist or occupant
High-speed: >40 mph (64 km/h)
Fall of >3 m in height
High‐speed injury from a projectile or an object

Result:

Please fill out required fields.
Advice

This tool does not replace clinical judgment; consider the broader clinical context when deciding management.

Management
  • If any criteria are met: Proceed with a head CT to evaluate for intracranial injury.

  • If no criteria are met: Monitor and discharge after a period of observation with instructions, if clinically appropriate.