UMEM Educational Pearls

Title: PECARN Head Injury Rule

Posted: 8/10/2013 by Rose Chasm, MD (Updated: 12/26/2024)
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Clinically important traumatic brain injuries are rare in children. The PECARN study provides decision rules for when to avoid unnecessarily obtaining a CT for children who have suffered head trauma.

For children < 2 years old: <0.02% risk of clinically important TBI

Normal mental status
No scalp hematoma, except frontal
Loss of consciousness < 5 seconds
No palpalble skull fracture
Normal behavior
Nonsevere mechanism (fall < 3ft, pedestrian struck, rollover MVC)

For children > 2 years old: <0.05% risk of clinically important TBI

Normal mental status
No signs of basilar skull fracture
No loss of consciousness
No vomiting
No severe headache
Nonsever mechanism (fall < 5ft, pedestrian struck, rollover MVC)

References

Kuppermann N, et al. Pediatric Emergency Care Applied Research Network. Identification of childrent at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009 Oct 3;374(9696):1160-70.