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RE: “CATCH: a clinical decision rule for the use of computed tomography in children with minor head injury.”1 This team has done a great job in giving us rural physicians a guiding hand in a clinically difficult situation. However, one thing caught my eye. It was the concept of “irritability on examination” as one of the major high-risk criteria for whether to send a child for a CT scan, which usually includes contacting a tertiary hospital, arranging transport and finding an accepting physician. This point needs more clarity. On an average day in the emergency department, irritability is not uncommon, especially in younger children. There are at least a few who become irritable at the thought of having a light shone in their eyes or an otoscope placed in their ears. If every child with a minor head injury who becomes irritable when examined starts getting a CT scan, this could increase the number done, rather than decrease it, which would be counterproductive to the aim of the study.
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/4/341#307752