cliot (version 1.0.0)

chalice_head_injury_rule: CHALICE Rule (Children's Head Injury Algorithm for the Prediction of Important Clinical Events)

Description

Applies the CHALICE clinical decision rule to identify children with minor head injury who are at high risk for significant intracranial pathology and require a CT scan. The rule is considered positive if any one of the history, mechanism, or examination criteria is met.

Usage

chalice_head_injury_rule(age_years, gcs_score, witnessed_loc_gt_5min,
                         amnesia_gt_5min, abnormal_drowsiness, vomiting_ge_3,
                         suspicion_nai, seizure, high_speed_mva, fall_gt_3m,
                         high_speed_object, open_depressed_fx_tense_fontanelle,
                         basal_skull_fx_signs, focal_neuro_deficit,
                         scalp_swelling_laceration_gt_5cm)

Value

A list containing:

Recommendation

"CT Head Indicated" or "CT Head Not Indicated".

Risk_Factors_Present

List of specific criteria met that triggered the recommendation.

Arguments

age_years

Numeric. Patient age in years. (Used to adjust GCS threshold and swelling criteria).

gcs_score

Numeric. Glasgow Coma Scale score. (Positive if < 14, or < 15 if age < 1 year).

witnessed_loc_gt_5min

Numeric (0 or 1). Witnessed Loss of Consciousness > 5 minutes. (1 = Yes).

amnesia_gt_5min

Numeric (0 or 1). History of amnesia > 5 minutes. (1 = Yes).

abnormal_drowsiness

Numeric (0 or 1). Abnormal drowsiness (drowsy, or only responding to voice/pain). (1 = Yes).

vomiting_ge_3

Numeric (0 or 1). >= 3 episodes of vomiting after injury. (1 = Yes).

suspicion_nai

Numeric (0 or 1). Suspicion of Non-Accidental Injury (Child Abuse). (1 = Yes).

seizure

Numeric (0 or 1). Seizure after injury (in patient without epilepsy). (1 = Yes).

high_speed_mva

Numeric (0 or 1). High-speed road traffic accident (> 40 mph / 64 kph) as pedestrian, cyclist, or occupant. (1 = Yes).

fall_gt_3m

Numeric (0 or 1). Fall from height > 3 meters. (1 = Yes).

high_speed_object

Numeric (0 or 1). High-speed injury from projectile or falling object. (1 = Yes).

open_depressed_fx_tense_fontanelle

Numeric (0 or 1). Suspicion of open or depressed skull fracture or tense fontanelle. (1 = Yes).

basal_skull_fx_signs

Numeric (0 or 1). Signs of basal skull fracture (Battle's sign, panda eyes, hemotympanum, CSF leak). (1 = Yes).

focal_neuro_deficit

Numeric (0 or 1). Focal neurological deficit. (1 = Yes).

scalp_swelling_laceration_gt_5cm

Numeric (0 or 1). Bruise, swelling, or laceration > 5cm on head. (1 = Yes). Note: Only triggers rule if age < 1 year.

References

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):885-891. doi:10.1136/adc.2005.083980

Examples

# Example 1: High Risk Infant
# 6 months old, Swelling > 5cm
chalice_head_injury_rule(0.5, 15, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 1)

# Example 2: Low Risk Child
# 5 years old, GCS 15, minor fall, 1 vomit
chalice_head_injury_rule(5, 15, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0, 0)