LOC >5 mins, Amnesia >5 mins, Abnormal drowsiness, ≥3 vomits, Suspicion of non-accidental injury, or Post-traumatic seizure.
Examination Criteria
GCS <14 (or <15 if age <1yr), Suspected skull fracture, signs of basal fracture, or large head swelling (>5cm if age <1yr).
Mechanism Criteria
High-speed RTA (>40 mph / 65 kmh), Fall from >3 meters height, or high-speed projectile injury to the head.
Trial Standard
The CHALICE rule is the UK standard for pediatric head trauma, balancing diagnostic sensitivity with radiation stewardship.
Pediatric Sentinel Probe
Evaluate history, examination, and mechanism criteria to determine radiological indications for pediatric head trauma based on the CHALICE algorithm.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Evaluating children (< 16 years) with any head injury.
Determining the need for emergent head CT scanning.
Primary decision tool in UK/NICE-aligned protocols.
Use for any GCS, but specifically designed to identify "Important Clinical Events" (death, surgery, or CT abnormality).
Section 2
Formula & Logic
High-Risk Criteria (Any Present = CT)
History: LOC > 5m, Amnesia > 5m, Abnormal drowsiness, ≥3 vomits, Suspicion of NAI, or Seizure.
Examination: GCS < 14 (or < 15 if < 1yr), Basilar fracture signs, Open/depressed fracture, or Focal deficit.
Mechanism: Fall > 3m, MVC > 40mph, or High-speed projectile.
Section 3
Pearls/Pitfalls
Age Sensitivity
CHALICE is particularly sensitive to infants under 1 year of age. It mandates a CT for any scalp bruise, laceration, or swelling > 5cm in this age group, reflecting the high incidence of occult skull fractures in non-ambulatory children.
Section 4
Evidence Appraisal
Primary Reference
Derivation of the children's head injury algorithm for the prediction of important clinical events decision rule for head injury in children
Dunning J et al. • Arch Dis Child. 2006;91(11):885-891
Developed through a large prospective cohort study in UK emergency departments to create a sensitive rule for identifying pediatric head injury patients requiring CT imaging. It is now the recommended tool by NICE (National Institute for Health and Care Excellence).
