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




head CT scan


both present

head CT scan


primary findings but not secondary



primary absent

CT scan not recommended


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