The Pediatric Emergency Care Applied Research Network (PECARN) developed clinical decision rules which help to identify a child with minor head trauma who should or should not have brain imaging studies.


Patient selection: child >= 2 and <= 16 years oldwith blunt head injury and an initial Glasgow coma score 14 or 15, seen in Emergency Department within 24 hours


Outcome: clinically important traumatic brain injury (ciTBI)


High risk indications::

(1) GCS 14

(2) altered mental status

(3) signs of basilar skull fracture


Intermediate risk – both of the following:

(1) one or more of the following:

(1a) vomiting

(1b) loss of consciousness (LOC)

(1c) severe mechanism of injury (ejection after motor vehicle crash, death of another passenger, rollover, pedestrian hit by motorized vehicle, bicyclist without helmet hit by motorized vehicle, fall > 0.9 meters, head struck by a high-impact object)

(1d) severe headache

(2) one or more of the following:

(2a) multiple findings

(2b) worsening symptoms


High Risk

Intermediate Risk




head CT scan


both present

head CT scan


primary findings but not secondary



primary absent

CT scan not recommended


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