ToolsCalculators
CHALICE (Children's Head injury ALgorithm for the prediction of Important Clinical Events) Rule
Identifies children with head injury at high risk of clinically significant intracranial injury.
CHALICE (Children's Head injury ALgorithm for the prediction of Important Clinical Events) Rule
Witnessed loss of consciousness >5 minutes (history)
Amnesia – antegrade or retrograde – >5 minutes (history)
Abnormal drowsiness for the situation (history)
3 or more discrete episodes of vomiting after head injury (history)
Suspicion of non-accidental injury (history)
Seizure after head injury with no prior history of epilepsy (history)
GCS <14 (or <15 if under 1 year old) (examination)
Suspected penetrating or depressed skull injury, or tense fontanelle (examination)
Signs of basal skull fracture – CSF/blood from ear or nose, panda eyes, Battle's sign, hemotympanum, facial crepitus or serious facial injury (examination)
Positive focal neurological signs – motor, sensory, coordination, or reflex abnormality (examination)
Bruise, swelling, or laceration >5 cm if under 1 year old (examination)
High-speed road traffic accident as pedestrian, cyclist, or occupant, >40 mph (mechanism)
Fall from a height >3 metres (mechanism)
High-speed injury from a projectile or an object (mechanism)
ResultCT not required by CHALICE
No CHALICE history, examination, or mechanism criteria are present.
When to use
- Children (typically under 16 years) presenting to the emergency department after head injury, to select those who require CT.
Formula
Any single positive criterion across the history, examination, and mechanism categories → CT recommended.
Pearls and pitfalls
- Derived and validated in the UK; performance may differ from North American rules such as PECARN or CATCH.