Healthcare & Clinical
CHALICE Pediatric Head Injury CT Rule (UK NICE Age-Stratified Formula)
Evaluate Joel Dunning’s 22,772-child UK CHALICE rule—checking age-specific Infant (< 1 yr: GCS < 15 or scalp swelling > 5 cm) vs. Child (1–15 yr: GCS < 14) thresholds alongside History, Exam, and High-Energy Mechanism triggers.
Apply all-comer pediatric head trauma triage—including age < 1 yr infant fontanelle & > 5 cm scalp thresholds!
Unlike PECARN and CATCH which restrict enrollment by GCS or symptom entry gates, Joel Dunning et al. (2006, Archives of Disease in Childhood) derived the Children’s Head Injury Algorithm for the Prediction of Important Clinical Events (CHALICE) across ALL 22,772 children (< 16 yr) presenting to UK emergency departments with any head injury—forming the backbone of UK NICE Head Injury Guidelines!
Notice CHALICE’s two vital Infant (< 1 year) vs. Older Child (1 to < 16 years) age-specific examination triggers: (1) GCS threshold is GCS < 15 if Age < 1 year, versus GCS < 14 if Age >= 1 year; and (2) Scalp bruise, swelling, or laceration > 5 cm triggers cranial CT ONLY in infants Age < 1 year! Combine those with CHALICE History triggers (witnessed LOC > 5 min, amnesia > 5 min, abnormal drowsiness, >= 3 discrete vomits, suspicion of non-accidental injury, or post-traumatic seizure), Exam triggers (penetrating/depressed injury or tense fontanelle, basal skull fracture signs, focal neurology), and High-Speed Mechanism triggers (MVA > 40 mph, fall > 3 meters, or high-speed projectile/object)!
| CHALICE Domain (< 16 Years All-Comer Head Trauma) | Specific Clinical Triggers | Age-Specific Threshold Note |
|---|---|---|
| Infant-Sensitive Exam | GCS Cutoff & Scalp Swelling/Laceration Size | Age < 1y: GCS < 15 or Swelling > 5 cm; Age >= 1y: GCS < 14 |
| History Domain (6 items) | LOC > 5m, Amnesia > 5m, Drowsy, >= 3 Vomits, NAI, Seizure | Any 1 Present -> Cranial CT Required |
| Exam & Mechanism (6 items) | Tense Fontanelle/Depressed, Basal Fx, Focal Neuro, >40mph/Fall>3m | All Negative -> Low Risk Discharge / Observation |
Age-Stratified CHALICE Positive Trigger Count
Applies Infant (B2 < 1 yr) vs. Child (B2 >= 1 yr) cutoffs to GCS (B3) and scalp lesion size in cm (B4), plus vomiting count >= 3 (B5 >= 3) and remaining History/Exam/Mechanism flags (B6:B8).
=IF(IF(B2 < 1, B3 < 15, B3 < 14), 1, 0) + IF(AND(B2 < 1, B4 > 5), 1, 0) + IF(B5 >= 3, 1, 0) + IF(B6 = 1, 1, 0) + IF(B7 = 1, 1, 0) + IF(B8 = 1, 1, 0)CHALICE Cranial CT Clinical Decision
Validates pediatric age < 16 yr and recommends Cranial CT if >= 1 CHALICE trigger is positive.
=IF(OR(B2 < 0, B2 >= 16, B3 < 3, B3 > 15), "Outside Pediatric CHALICE (<16y) Scope", IF((IF(IF(B2 < 1, B3 < 15, B3 < 14), 1, 0) + IF(AND(B2 < 1, B4 > 5), 1, 0) + IF(B5 >= 3, 1, 0) + B6 + B7 + B8) >= 1, "Cranial CT Indicated (CHALICE Positive)", "No Cranial CT Required (CHALICE Low Risk)"))Try the example
Use the original values or change them to test your understanding.