Head injuries in children over 2yo are stress provoking as well. Here are the rules for that age group, piggy-backing on last week's pearl, based on a large (42,412 children, 31,694 >2yo) multi-center trial conducted by PECARN.
In children >2yo, if all of the following criteria are met, there is 99.95% chance that no clinically important traumatic brain injury exists (defined as an injury requiring intervention):
normal mental status
no loss of consciousness
no vomiting
non-severe injury mechanism
no signs of basilar skull fracture
no severe headache
No children in either low risk group required neurosurgical intervention.
References
Kuppermann N, Holmes JF, Dayan PS, et al. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study.Lancet2009;374:1160-1170
