Description

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 less than 2 years old with 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) palpable skull fracture

 

Intermediate risk – both of the following:

(1) one or more of the following:

(1a) occipital, parietal and/or temporal hematoma

(1b) loss of consciousness >= 5 seconds

(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) not acting normal according to paraents

(2) one or more of the following:

(2a) multiple findings

(2b) worsening symptoms

(2c) age < 3 months

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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