HPI: 6 yo male presents s/p un-helmeted fall from bicycle. Fall unwitnessed, mom reports child came running inside immediately, crying, holding head. Applied ice to developing hematoma, child back to playing with siblings in 15-20 minutes. Pt presents to ED 6 hours after fall- urged to seek treatment by NP over phone when mom called concerned that child "acting funny" at bedtime. Asking to "wear shoes in bed," claiming he saw "pasta in his sister's hair," that it "was time to wake up." Per mom, no change in level of alertness, no nausea/vomiting, no complaints of HA or changes in vision.
Exam: VS- 110/65 76 12 37.1 99%RA
Gen- AAO x3, NAD, laughing, smiling, answers questions appropriately
HEENT- 2cm boggy hematoma above R eye, PERRL, EOMI, no nystagmus, no papilledema, TMs benign, no Battle's sign, nares and oropharynx benign
Neck- supple, full ROM, no spinous process tenderness
Neuro- CN II-XII intact, no focal deficits, finger-nose-finger with no dysmetria, able to run up and down hall without difficulty
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Evidence:
Osmond, M et al. CATCH: a clinical decision rule for the use of computed tomography in children with minor head injuries. CMAJ 2010 Mar 9;182(4):341-8
Prospective study conducted at 10 Canadian Pediatric EDs
-3866 subjects age 0-16 with minor head trauma
-Identified key variables of hx and exam associated with abnormal findings on head CT and/or need for neurosurgical intervention
-CATCH rule 98.1% sensitive and 50.0% specific for CT findings/need for intervention
-requires additional prospective validation
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