🧒 PECARN Pediatric Head Injury CT Rule
Apply the PECARN pediatric head injury rule to decide whether a child with minor head trauma (GCS 14–15) needs a head CT.
PECARN Pediatric Head Injury CT Rule
Age
High-risk · GCS ≤ 14 or altered mental status (agitation, somnolence, repetitive questioning, slow response)
High-risk · signs of skull fracture (< 2 y: palpable/depressed fracture; ≥ 2 y: basilar skull fracture signs)
Intermediate · loss of consciousness (< 2 y: ≥ 5 s; ≥ 2 y: any history of LOC)
Intermediate · severe mechanism of injury
[< 2 y] Intermediate · non-frontal (occipital/parietal/temporal) scalp hematoma
[< 2 y] Intermediate · not acting normally per parent
[≥ 2 y] Intermediate · vomiting
[≥ 2 y] Intermediate · severe headache
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
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.