Recommendation ID
CG176/2
Question
Criteria for CT head scanning:- What is the clinical and cost effectiveness of the 2014 NICE guideline recommendation on CT head scanning versus clinical decision rules (including CHALICE, CATCH and PECARN) for selecting children and infants for head CT scanning?
Any explanatory notes
(if applicable)
Why this is important:- The recommendations in this updated guideline for determining which patients need a CT head scan are based on the CHALICE clinical decision rule. CHALICE was derived in the UK but has yet to be validated, and limited evidence has been identified since the NICE clinical guideline was published in 2007. There is a need for a prospective validation and direct comparison of the 2014 NICE guideline and CHALICE, CATCH and PECARN clinical decision rules in a UK setting to determine diagnostic accuracy (sensitivity, specificity, and predictive values for intracranial injury and the need for neurosurgery) and cost effectiveness within the relevant population to which the NICE guideline is applied.
The study should be a prospective study with economic evaluation and should capture subgroups by age, separating out infants (under 2 years), children and young people (under 16 years) and adolescents (16–18 years). The results of such a study will confirm whether current practice is optimal and, if not, which would be the ideal clinical decision rule to implement in a UK population. To warrant recommendation of a different clinical decision rule and a consequent substantial change in practice, significant improvement in diagnostic accuracy must be demonstrated. This can only be done through such a prospective comparative validation study performed in our population.

Source guidance details

Comes from guidance
Head injury: assessment and early management
Number
CG176
Date issued
January 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 28/02/2014