Pedemy All toolsAnswer one question at a time. The result gives the CT decision, the risk of brain injury, and discharge advice. Tap any earlier answer to change it.
This tool applies the PECARN rule to children with minor blunt head trauma to help clinicians decide whether a head CT is needed. It gives the CT decision, the estimated risk of clinically important brain injury, and discharge advice.
The rule applies within 24 hours of injury with a GCS of 14 or 15. Children with lower GCS, bleeding disorders or anticoagulants, a VP shunt, or suspected abuse are routed to separate advice. The criteria differ by age. Under 2 years, high-risk findings are GCS 14, other altered mental status, or a palpable skull fracture; intermediate findings are an occipital, parietal or temporal scalp hematoma, loss of consciousness of 5 seconds or longer, a severe mechanism, or not acting normally per a parent. At 2 years or older, high-risk findings include signs of basilar skull fracture, and intermediate findings are any loss of consciousness, vomiting, a severe mechanism or severe headache.
High-risk findings favor CT (risk about 4.4% under 2 and 4.3% at 2 or older). One isolated intermediate finding usually means observation for 4 to 6 hours from injury, and no findings means CT is not needed. It is based on Kuppermann et al. (Lancet 2009), the 2018 CDC pediatric mild TBI guideline and the 2019 severe TBI guidelines.
CT is recommended with a high-risk finding: GCS 14, other altered mental status, or a palpable skull fracture under 2 years, or signs of basilar skull fracture at 2 or older. With several intermediate findings, worsening symptoms or age under 3 months, CT is reasonable.
Car crash with ejection, rollover or death of another passenger; pedestrian or unhelmeted cyclist hit by a motor vehicle; head struck by a high-impact object; or a fall over 3 ft (0.9 m) under 2 years, or over 5 ft (1.5 m) at 2 or older.
With one isolated intermediate-risk finding, observe with repeated neurologic checks until 4–6 hours after the injury, and obtain a CT if symptoms worsen or new findings appear. The risk of clinically important brain injury in this group is about 0.9%.
Free to use on clinic, school, blog or hospital pages. Copy this code into your page: