CATCH (Canadian Assessment of Tomography for Childhood Head injury) Rule

CATCH Rule
High Risk (need for neurosurgical intervention):
GCS <15 at 2 Hours After Injury
Suspected Open or Depressed Skull Fracture
Worsening Headache
Irritability on Examination
Medium Risk (brain injury on CT):
Any Sign of Basal Skull Fracture
Large, Boggy Scalp Hematoma
Dangerous Mechanism (MVC, fall ≥3 ft / 5 stairs, bicycle without helmet)
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Predicts clinically significant head injuries in children.

Why Use

Original study included detailed sensitivity analysis for combinations of risk factors, perhaps giving a more nuanced approach to the decision to obtain CT.

When to Use

Pediatric patients up to 16 years old with minor head injury and: Initial GCS ≥13 on physician determination, Injury within 24 hours, AND At least one of the following: Blunt trauma to the head with witnessed loss of consciousness. Definite amnesia. Witnessed disorientation. Vomiting two or more times at least 15 minutes apart. Persistent irritability in a child under two years. Do not use in any of the following situations: Penetrating skull injury. Depressed fractures. Acute focal neurological deficit. Chronic generalized developmental delay. Suspected child abuse. Returning for re-evaluation after prior head injury. Pregnant patients.

Formula

CT of the head is required only for children with minor head injury* and any one of the following findings: High risk (need for neurologic intervention) GCS <15 at two hours after injury. Suspected open or depressed skull fracture. History of worsening headache. Irritability on examination. Medium risk (brain injury on CT scan) Any sign of basal skull fracture (e.g., hemotympanum, “raccoon” eyes, otorrhea or rhinorrhea of the cerebrospinal fluid, Battle’s sign). Large, boggy hematoma of the scalp. Dangerous mechanism of injury (e.g., motor vehicle collision, fall from ≥3 ft (91 cm) or 5 stairs, fall from bicycle with no helmet). *Minor head injury is defined as injury within the past 24 hours associated with witnessed loss of consciousness, definite amnesia, witnessed disorientation, persistent vomiting (more than one episode) or persistent irritability (in a child <2 years) with GCS 13–15.

Pearls / Pitfalls

Identifies high risk patients with specific signs and symptoms. Generalizability is limited, as it uses numerous strict inclusion and exclusion criteria. Less sensitive than the PECARN Algorithm . Original study included detailed sensitivity analysis for combinations of risk factors, perhaps giving a more nuanced approach to the decision to obtain CT. Intoxicated patients were not excluded, making GCS estimation potentially unreliable.

Management

Patients require CT if they have any of the high risk or medium risk factors. High risk predicts need for neurologic intervention; medium risk predicts brain injury on CT scan.

Advice

Patients who do not meet criteria for imaging should always be counseled about concussion and its symptoms and strict head injury return precautions (e.g. vomiting, somnolence, altered mental status). Many still recommend a period of observation after head injury.

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