MDCalc

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

Predicts clinically significant head injuries in children.

Use in patients up to 16 yrs with minor head injury and initial Glasgow Coma Scale 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.

GCS <15 at 2 hrs after injury
Suspected open or depressed skull fracture
History of worsening headache

Irritability on exam

Any sign of basal skull fracture

Hemotympanum, raccoon eyes, CSF otorrhea or rhinorrhea, Battle’s sign

Large boggy scalp hematoma

Dangerous mechanism of injury
MVC, fall from ≥3 ft (91 cm) or 5 stairs, fall from bicycle with no helmet

Result:

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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.

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