Indications for computed tomography of the head in children following head trauma: shortcomings in the NICE, CATCH, SIGN, PECARN, and CHALICE guidelines

Introduction
Several guidelines exist for head computed tomography (CT) in children after trauma (NICE, CATCH, SIGN, PECARN, CHALICE), but they differ significantly, potentially leading to inconsistent diagnostic practices.

Methods
We analyzed and compared CT indication criteria across the five guidelines, focusing on differences, omissions, and unclear definitions. No human/animal subjects; IRB approval not required.

Results
Only few indications was common to all five guidelines. For example, “warfarin use” is included only in NICE (and excluded in PECARN); “irritability” appears only in CATCH, while “severe mechanism of injury” is emphasized by PECARN, NICE, and CHALICE, but poorly defined. Several symptoms (e.g., “worsening headache”) lack clear definitions. None of the guidelines explicitly address multisystem trauma.

Conclusions
Current pediatric head CT guidelines are inconsistent and have important limitations. Harmonization and clarification of vague terms are recommended to improve decision-making and patient safety.