🧒 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.
Clinical takeaway
Applies only to minor trauma with GCS 14–15.
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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.
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
Frequently asked questions
- What is 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.
- How is PECARN Pediatric Head Injury CT Rule calculated? What is the core formula?
- High-risk (GCS ≤ 14 / altered mental status, or skull-fracture signs) → CT. Intermediate features → CT vs observation. None → CT not recommended.
- When is PECARN Pediatric Head Injury CT Rule used?
- Reduce unnecessary CT in children ≤ 18 y, with separate < 2 y and ≥ 2 y pathways.
- What are the key clinical points for PECARN Pediatric Head Injury CT Rule?
- 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.
- What are the limits and cautions when using PECARN Pediatric Head Injury CT Rule?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- 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）