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
Evaluation
present
NA
head CT scan
absent
both present
head CT scan
absent
primary findings but not secondary
observation
absent
primary absent
CT scan not recommended
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