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[Comment] Paediatric head imaging decisions are not child’s play

Clinicians who care for paediatric patients with blunt head injury must reliably identify all patients harbouring serious injuries and avoid catastrophic misses that could lead to permanent disability and death.1–4 CT head imaging plays a key part in injury assessment, but is not suitable for most children because of cost, inconvenience, and risk of radiation-induced malignant transformation.1,2,5,6 Clinical decision tools, including the Pediatric Emergency Care Applied Research Network (PECARN),2 Canadian Assessment of Tomography for Childhood Head Injury (CATCH),4 and Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE)3 rules, have been developed to guide and inform paediatric CT head imaging decisions; however, concerns about the validity of these instruments prompted Franz Babl and colleagues to do a multicentre validation study1 that assessed their external performance.