UMEM Educational Pearls

Category: Pediatrics

Title: To CT or not to CT, Part II

Keywords: head CT, trauma, pediatrics, head injury (PubMed Search)

Posted: 2/11/2011 by Adam Friedlander, MD (Updated: 7/12/2024)
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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.



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