PECARN Pediatric Head Injury Rule

PECARN (Kuppermann 2009)

Stratifies children under 18 with minor head trauma (GCS 14-15) into CT recommended, observation versus CT, or very low risk with no CT, using separate predictor trees for children younger than 2 years and children 2 years or older.

Also searched as: CT · decision rule · radiation dose · emergency · children · tbi

Age group

The rule has separate predictor trees for the two age groups.

GCS 14 or less, or other signs of altered mental status

Agitation, somnolence, repetitive questioning, or slow response to verbal communication.

Palpable skull fracture (under-2 group only)

Applies to the under-2 tree. Leave unanswered for the 2-and-older group.

Signs of basilar skull fracture (2-and-older group only)

Retroauricular bruising (Battle sign), periorbital bruising, CSF otorrhea or rhinorrhea, or hemotympanum. Leave unanswered for the under-2 group.

Occipital, parietal, or temporal scalp hematoma (under-2 group only)

Intermediate predictor in the under-2 tree. Leave unanswered for the 2-and-older group.

Loss of consciousness lasting 5 seconds or more (under-2 group only)

Intermediate predictor in the under-2 tree. Leave unanswered for the 2-and-older group.

Not acting normally according to the parent or caregiver (under-2 group only)

Intermediate predictor in the under-2 tree. Leave unanswered for the 2-and-older group.

Any loss of consciousness (2-and-older group only)

Intermediate predictor in the 2-and-older tree. Leave unanswered for the under-2 group.

History of vomiting (2-and-older group only)

Intermediate predictor in the 2-and-older tree. Leave unanswered for the under-2 group.

Severe headache (2-and-older group only)

Intermediate predictor in the 2-and-older tree. Leave unanswered for the under-2 group.

Severe mechanism of injury

Motor vehicle crash with patient ejection, death of another passenger, or rollover; pedestrian or bicyclist without helmet struck by a motor vehicle; fall from more than 0.9 m (3 ft) if under 2 years or more than 1.5 m (5 ft) if 2 years or older; head struck by a high-impact object.

Information

Incomplete input

Select the age group: the PECARN rule uses different predictor trees for children under 2 years and for those 2 years or older.

How this tool works

The PECARN rules were derived and validated in more than 42,000 children with minor blunt head trauma to identify those at very low risk of clinically important traumatic brain injury (ciTBI), for whom CT can be avoided. Children younger than 2 years and those 2 years or older have separate predictor sets and slightly different severe-mechanism definitions (falls greater than 0.9 m in the younger group, greater than 1.5 m in the older group). Children with none of the predictors have a ciTBI risk of roughly 0.02% (under 2 years) and 0.05% (2 years or older); children with intermediate predictors fall into an observation-versus-CT category where clinician judgment, symptom trajectory, and caregiver preference guide the decision.

References

Implemented from the cited published sources. Educational use only; confirm against current guidelines before clinical use.

Clinical questions that use this

Vetting guides that reach for this tool.

Head injury in children

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