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1 CT CT CT CT CT PECARN CATCH CHALICE NICE2014 clinical significant head injury CT CT CT CT CT CT CT CT CT CT 1 CT PECARN 2 CATCH 3 CHALICE NICE2014 CT clinically important traumatic brain injury citbi 2 2 CT CT CT CT CT CT PECARN 7

2 歳未満児の場合 1 意識レベルが GCS14 2 意識状態の変容 3 頭蓋骨骨折が触知される 頭部 CT を推奨 2 歳以上の場合 1 意識レベルが GCS14 2 意識状態の変容 3 頭蓋底骨折の徴候 頭部 CT を推奨 4 後頭部や頭頂部そして側頭部に皮下血腫がある 55 秒以上の意識消失 6 重篤な受傷機転 7 親からみて普段と違う GCS Glasgow coma scale 頭部 CT を推奨しない 以下の条件で経過観察もしくは頭部 CT を考慮する 担当医の裁量 複数の所見か単一か 症状が悪化 生後 3 か月未満 親の希望 4 意識消失 5 嘔吐 6 重篤な受傷機転 7 激しい頭痛 頭部 CT を推奨しない 1 PECARN 2 以下の条件で経過観察もしくは頭部 CT を考慮する 担当医の裁量 複数の所見か単一か 症状が悪化 親の希望 CATCH CHALICE NICE2014 CT 1 PECARN Pediatric Emergency Care Applied Research Network Glasgow coma scale GCS , CT 2 GCS % citbi 2 4.4% CT 3 4 CT % citbi 0.9% CT 2 2 GCS % citbi 4.3% CT % citbi 0.8% 4 1 CT citbi CT 1 2 GCS citbi 2 CATCH Canadian Assessment of Tomography for Childhood Head injury CT GCS , GCS 15 CT 3 3 8

3 CATCH 3 2 CHALICE 4 24 GCS GCS 15 CT GCS cm 40 m 3 m 7 1 CT GCS Glasgow coma scale 14 GCS Glasgow coma scale 7 1 CT 3 CHALICE Children s Head injury Algorithm for the Prediction of Important Clinical Events NICE2014 National Institute for Healthy and Care Excellence CT GCS cm 40 m 3 m 22,772 CT % 87% clinical significant head injury CT 14% 4 CT PECARN CATCH CHALICE CT PECARN m m CATCH 3 91 cm 5 CHALICE NICE m CT PECARN CATCH CHALICE NICE m ,137 3 CT CHALICE 99% PECARN 2 75% 2 76% CATCH 25% CATCH PECARN % % CATCH 95.2% 88.7% CHALICE 92.3% CT 99% CT CHALICE 22.0% CATCH 30.2% PECARN 46.6% PECARN PECARN CT PECARN 9

4 CT PECARN CATCH CHALICE 5 PECARN CATCH 2 2 CT 1 CT CHALICE 100% 99.2% 95.2% 88.7% 92.3% 53.8% 45.8% 84.2% 56.4% 78.1% 2.0% 1.6% 2.5% 5.6% 7.9% 100.0% 100.0% 100% 99.4% 99.8% CT 46.6% 30.2% 22.0% 75% 76% 25% 99% CT 100 multi-detector CT 54.9 single-detector CT CT 24 CT 1, CT 1 CT % PECARN CATCH CHALICE CT CT 6 CT 2 CT 1 50 msv 1 3 msv msv 7 CT CT ,090 CT 24% 9 CT 10 ALARA 11 As Low As Reasonably Achievable CT 1 3 CT CT CT PECARN CATCH CHALICE CT CT CT 12 CT CT CT CT 10

5 CT CT CT CT CT CT 3 CT PECARN CATCH CHALICE NICE2014 CT CT CT Kuppermann N, Holmes JF, Dayan PS, et al Pediatric Emergency Care Applied Research Network PECARN. Identification of children at very low risk of clinically important brain injuries after head trauma a prospective cohort study. Lancet Osmond MH, Klassen TP, Wells GA, et al Pediatric Emergency Research Canada PERC Head Injury Study Group. CATCH a clinical decision rule for the use of computed tomography in children with minor head injury. CMAJ Dunning J, Daly JP, Lomas JP, Lecky F, Batchelor J, Mackway-Jones K Children s head injury algorithm for the prediction of important clinical events study group. 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 Babl FE, Borland ML, Phillips N, et al Paediatric Research in Emergency Departments International Collaborative PREDICT. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children a prospective cohort study. Lancet ICRP Publication. 87 CT Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours a retrospective cohort study. Lancet Mathews JD, Forsythe AV, Brady Z, et al. Cancer risk in 680,000 people exposed to computed tomography scans in childhood or adolescence data linkage study of 11 million Australians. BMJ f Berrington de González A, Darby S. Risk of cancer from diagnostic X-rays estimates for the UK and 14 other countries. Lancet The Society for Pediatric Radiology organized this multidisciplinary conference on August 18-19, The ALARA concept in pediatric CT intelligent dose reduction. Pediatr Radiol CT Head injury decision rules in pediatric patients Shoko Shimokawa Department of Neurosurgery, Faculty of Medicine, Saga University, Saga Head injuries in pediatric patients are a common presentation in an acute care setting, and clinicians must decide whether the pediatric patient should undergo cranial computed tomography CT. There are many CT scanners available in Japan, rendering immediate CT examinations possible in the emergency departments. However, the risk of radiation-induced cancer has been reported to be higher in Japan compared with that in Western countries. To date, three clinical decisions rules PECARN, CATCH, and CHALICE have been reported to determine the need for CT in children with head injuries. These clinical decision rules have been developed to identify children at a high risk of intracranial injuries, aiming to assist clinicians in minimizing the number of CT scans. If however, when the family of a pediatric patient expects a head CT examination to determine the extent of the injury, the clinicians should recommend CT. Furthermore, it is important to assess the suitability of the head CT scanner used on the basis of the clinical decisions rules and to explain care post head injuries. No To Hattatsu 2018;50:

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