CHALICE_rule v.1
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.
Predicts death, need for neurosurgical intervention or CT abnormality in children with head trauma.
Use to determine if there is a "Not low" risk and therefore a CT head is required. This is if any of the following criteria are present: History: - Witnessed loss of consciousness of >5 min duration. - History of amnesia (either antegrade or retrograde) of >5 min duration. - Abnormal drowsiness (defined as drowsiness in excess of that expected by the examining doctor). - ≥3 vomits after head injury (a vomit is defined as a single discrete episode of vomiting). - Suspicion of non‐accidental injury (NAI, defined as any suspicion of NAI by the examining doctor). - Seizure after head injury in a patient who has no history of epilepsy. Examination: - Glasgow Coma Score (GCS) <14, or GCS <15 if <1 year old. - Suspicion of penetrating or depressed skull injury, or tense fontanelle. - Signs of a basal skull fracture (defined as evidence of blood or cerebrospinal fluid from ear or nose, panda eyes, - Battle's sign, hemotympanum, facial crepitus, or serious facial injury). Positive focal neurologic sign (defined as any focal neurologic sign, including motor, sensory, coordination, or reflex abnormality). Presence of bruise, swelling or laceration >5 cm if <1 year old. Mechanism: -High‐speed road traffic accident either as pedestrian, cyclist or occupant (defined as accident with speed >40 mph). - Fall of >3 m in height. - High‐speed injury from a projectile or an object. If none of the above variables are present, the patient is at low risk of intracranial pathology. 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.
Do not use for children over 16 years old.
1. Dunning J, Daly JP, Lomas JP, et al. Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children. Arch Dis Child. 2006;91(11):885-91.
OBSERVATION.glasgow_coma_scale.v1, EVALUATION.chalice_rule.v0
