UMEM Educational Pearls

Category: Pediatrics

Title: PECARN Head Injury Rule

Posted: 8/10/2013 by Rose Chasm, MD (Updated: 12/8/2022)
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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.