PECARN Head Trauma

Rule

This rule was derived from the multicenter PECARN network with both a derivation and validation arm to detect clinically important traumatic brain (ciTBI) injury in children to age 18yrs old after blunt head trauma.

The rule stratifies patients < 2 years old and ≥2 years old.

PECARN Head CT Rule Algorithm

<2 years old

Any 1 of the following?

• GCS ≤14
• Altered Mental Status
• Palpable Skull Fracture

Then obtain a Non-Con Brain CT (4.4% risk of cTBI)

1 or more of the following?

• Non-frontal scalp hematoma
• LOC ≥ 5 seconds
• Severe injury mechanism
  • pedestrian or bicyclist without helmet struck by motorized vehicle
  • fall >1m or 3ft
  • head struck by high-impact object
• Abnormal activity per parents

Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)

≥2 years old - 18 years

Any 1 of the following?

• GCS ≤14
• Altered Mental Status
• Signs of a basilar skull fracture

Then obtain a Non-Con Brain CT (4.3% risk of cTBI)

1 or more of the following?

• History of vomiting^
• LOC
• Severe injury mechanism
  • Pedestrian or bicyclist without helmet struck by motorized vehicle
  • Fall >2m or 5ft
  • Head struck by high-impact object
• Severe headache

Then consider a Non-Con Brain CT or Observation (0.9% risk of cTBI)

^Consider observation in place of imaging in children with isolated vomiting (no other indication) as the sole risk factor (0.2% risk of cTBI)

See Also

EBQ:PECARN Pediatric Head CT Rule

References

Authors

Jeff Rogers, Ross Donaldson, Neil Young, Daniel Ostermayer