🧒 PECARN Pediatric Head Injury CT Rule
UseReduce unnecessary CT in children ≤ 18 y, with separate < 2 y and ≥ 2 y pathways.
StrataHigh-risk features carry ~4% ciTBI risk; intermediate ~0.8–0.9%; no predictors <0.05% — observation is prefer…
LimitsDo not apply to GCS ≤13, penetrating injury, or children outside the … · Intermediate pathway needs shared decision-making and reliable serial… · Clinical concern (e.g. worsening vomiting, new focal deficit) overrid…
SourceKuppermann N, et al. Lancet 2009. doi:10.1016/S0140-6736(09)61558-0 (PECARN)
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Applies only to minor trauma with GCS 14–15.
When to use
Reduce unnecessary CT in children ≤ 18 y, with separate < 2 y and ≥ 2 y pathways.
How it works
High-risk (GCS ≤ 14 / altered mental status, or skull-fracture signs) → CT. Intermediate features → CT vs observation. None → CT not recommended.
Key points
- Applies only to minor trauma with GCS 14–15.
- ciTBI risk ≈ 4% with high-risk, ≈ 0.8–0.9% intermediate, < 0.05% with none.
- Shared decision-making for the intermediate group.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Age | < 2 y |
|---|---|
| High-risk · GCS ≤ 14 or altered mental status (agitation, somnolence, repetitive questioning, slow response) | No |
| High-risk · signs of skull fracture (< 2 y: palpable/depressed fracture; ≥ 2 y: basilar skull fracture signs) | No |
| Intermediate · loss of consciousness (< 2 y: ≥ 5 s; ≥ 2 y: any history of LOC) | No |
| Intermediate · severe mechanism of injury | No |
| [< 2 y] Intermediate · non-frontal (occipital/parietal/temporal) scalp hematoma | No |
| [< 2 y] Intermediate · not acting normally per parent | No |
| [≥ 2 y] Intermediate · vomiting | No |
| [≥ 2 y] Intermediate · severe headache | No |
→PECARN dispositionCT not recommended
- High-risk features：Absent
- Intermediate features：Absent
| Age | ≥ 2 y |
|---|---|
| High-risk · GCS ≤ 14 or altered mental status (agitation, somnolence, repetitive questioning, slow response) | Yes |
| High-risk · signs of skull fracture (< 2 y: palpable/depressed fracture; ≥ 2 y: basilar skull fracture signs) | Yes |
| Intermediate · loss of consciousness (< 2 y: ≥ 5 s; ≥ 2 y: any history of LOC) | Yes |
| Intermediate · severe mechanism of injury | Yes |
| [< 2 y] Intermediate · non-frontal (occipital/parietal/temporal) scalp hematoma | Yes |
| [< 2 y] Intermediate · not acting normally per parent | Yes |
| [≥ 2 y] Intermediate · vomiting | Yes |
| [≥ 2 y] Intermediate · severe headache | Yes |
→PECARN dispositionCT recommended
- High-risk features：Present
- Intermediate features：Present
Verification & sources · governance
FAQ
Frequently asked questions
- Does PECARN Pediatric Head Injury CT Rule upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is PECARN Pediatric Head Injury CT Rule calculated in practice? Can you show a worked example?
- Inputs: Age < 2 y, High-risk · GCS ≤ 14 or altered mental status (agitation, somnolence, repetitive questioning, slow response) No, High-risk · signs of skull fracture (< 2 y: palpable/depressed fracture; ≥ 2 y: basilar skull fracture signs) No, Intermediate · loss of consciousness (< 2 y: ≥ 5 s; ≥ 2 y: any history of LOC) No, Intermediate · severe mechanism of injury No, [< 2 y] Intermediate · non-frontal (occipital/parietal/temporal) scalp hematoma No, [< 2 y] Intermediate · not acting normally per parent No, [≥ 2 y] Intermediate · vomiting No… → Result: PECARN disposition CT not recommended（High-risk features: Absent, Intermediate features: Absent） Inputs: Age ≥ 2 y, High-risk · GCS ≤ 14 or altered mental status (agitation, somnolence, repetitive questioning, slow response) Yes, High-risk · signs of skull fracture (< 2 y: palpable/depressed fracture; ≥ 2 y: basilar skull fracture signs) Yes, Intermediate · loss of consciousness (< 2 y: ≥ 5 s; ≥ 2 y: any history of LOC) Yes, Intermediate · severe mechanism of injury Yes, [< 2 y] Intermediate · non-frontal (occipital/parietal/temporal) scalp hematoma Yes, [< 2 y] Intermediate · not acting normally per parent Yes, [≥ 2 y] Intermediate · vomiting Yes… → Result: PECARN disposition CT recommended（High-risk features: Present, Intermediate features: Present）