Editor's Capsule Summary
What is already known on this topic
Some advocate clinical decision rules to guide head computed tomography (CT) use in injured children.
What question this study addressed
How do 3 clinical decision rules compare with clinical judgment?
What this study adds to our knowledge
In this prospective study of 1,009 injured children, only physician baseline ordering practice and Pediatric Emergency Care Applied Research Network (PECARN) identified all of the 21 clinically important brain injuries, with PECARN being slightly more specific. Physician risk estimation missed 1 injury, and 2 other decision rules were insufficiently sensitive.
How this is relevant to clinical practice
Baseline physician ordering practice and PECARN outperformed 2 other clinical decision rules for head CT use in injured children.