Emergency

PECARN Pediatric Head Trauma

Identifies children at very low risk of clinically-important traumatic brain injury after blunt head trauma, supporting the decision to forgo CT imaging. Two age-stratified rules: under 2 years and 2 years or older.

Age group

Altered mental status (GCS < 15, agitation, somnolence, repetitive questions, slow to respond)

High-risk feature in both age groups

Palpable skull fracture (< 2 yrs only)

Signs of basilar skull fracture (≥ 2 yrs only)

Battle sign, raccoon eyes, hemotympanum, CSF rhinorrhea/otorrhea

Loss of consciousness ≥ 5 seconds (< 2 yrs)

Any loss of consciousness (≥ 2 yrs)

Vomiting (≥ 2 yrs)

Severe mechanism of injury

MVC with ejection / death / rollover; pedestrian or unhelmeted bicyclist struck; fall > 0.9 m (<2y) / > 1.5 m (≥2y); head struck by high-impact object

Non-frontal scalp hematoma (< 2 yrs)

Occipital, parietal, or temporal

Not acting normally per parent (< 2 yrs)

Severe headache (≥ 2 yrs)

Source

Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, Atabaki SM, Holubkov R, et al.. Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet 2009.

PMID 19758692 Ask House about this